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Background <p>High-volume hospitals tend to have better outcomes in complex surgeries, but outcome variations and volume thresholds complicate conclusions. This systematic review/meta-analysis assessed the impact of hospital volume on postoperative outcomes after esophagogastric surgery and identified volume thresholds beyond which benefits plateau.</p> Methods <p>PubMed/MEDLINE was searched for cohort studies (2013–2023) on volume and outcomes after esophagectomy/gastrectomy for cancer. Primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, complications, length of stay (LOS), and long-term survival. The meta-analysis compared hospital volumes using odds ratios (ORs) for binary outcomes, hazard ratios (HRs) for survival, and mean differences (MDs) for LOS. A generalized estimating equation model assessed the continuous association between volume and 30-day mortality. Segmented regression identified volume thresholds where outcomes plateaued.</p> Results <p>Of 2679 articles, 56 studies on hospital volume and outcomes after esophagectomy and gastrectomy for cancer were included. High-volume hospitals (4–239 resections/year) showed lower 30-day mortality (OR 0.51; 95% confidence interval [CI] 0.43–0.59), 90-day mortality (OR 0.65; 95% CI 0.56–0.74), fewer complications (OR 0.83; 95% CI 0.74–0.94), shorter LOS (MD -1.50 days; 95% CI 0.97–2.03), and better survival (HR 0.83; 95% CI 0.78–0.87). Each doubling of volume demonstrated a significant reduction in 30-day mortality for esophagectomy (OR/volume-doubling 0.74; 95% CI 0.68–0.81) and gastrectomy (OR/volume-doubling 0.70; 95% CI 0.61–0.82). Breakpoints were identified at 43 cases for esophagectomy and 15 cases for gastrectomy per year, beyond which the association plateaued.</p> Conclusions <p>Higher hospital volume is associated with lower mortality, reduced complications, shorter LOS, and improved survival. Identified thresholds exceed existing policy benchmarks, supporting further centralization of esophagogastric cancer surgery.</p>

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The Impact of Hospital Volume on Postoperative Outcomes for Esophagectomy and Gastrectomy: A Systematic Review and Meta-analysis

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2026年4月1日

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  • Cezanne D. Kooij,
  • Irene S. Zuin,
  • Alexandre Challine,
  • Jessie A. Elliott,
  • Jelle P. Ruurda,
  • Richard van Hillegersberg,
  • Lucas Goense

摘要

Background

High-volume hospitals tend to have better outcomes in complex surgeries, but outcome variations and volume thresholds complicate conclusions. This systematic review/meta-analysis assessed the impact of hospital volume on postoperative outcomes after esophagogastric surgery and identified volume thresholds beyond which benefits plateau.

Methods

PubMed/MEDLINE was searched for cohort studies (2013–2023) on volume and outcomes after esophagectomy/gastrectomy for cancer. Primary outcome was 30-day mortality. Secondary outcomes included 90-day mortality, complications, length of stay (LOS), and long-term survival. The meta-analysis compared hospital volumes using odds ratios (ORs) for binary outcomes, hazard ratios (HRs) for survival, and mean differences (MDs) for LOS. A generalized estimating equation model assessed the continuous association between volume and 30-day mortality. Segmented regression identified volume thresholds where outcomes plateaued.

Results

Of 2679 articles, 56 studies on hospital volume and outcomes after esophagectomy and gastrectomy for cancer were included. High-volume hospitals (4–239 resections/year) showed lower 30-day mortality (OR 0.51; 95% confidence interval [CI] 0.43–0.59), 90-day mortality (OR 0.65; 95% CI 0.56–0.74), fewer complications (OR 0.83; 95% CI 0.74–0.94), shorter LOS (MD -1.50 days; 95% CI 0.97–2.03), and better survival (HR 0.83; 95% CI 0.78–0.87). Each doubling of volume demonstrated a significant reduction in 30-day mortality for esophagectomy (OR/volume-doubling 0.74; 95% CI 0.68–0.81) and gastrectomy (OR/volume-doubling 0.70; 95% CI 0.61–0.82). Breakpoints were identified at 43 cases for esophagectomy and 15 cases for gastrectomy per year, beyond which the association plateaued.

Conclusions

Higher hospital volume is associated with lower mortality, reduced complications, shorter LOS, and improved survival. Identified thresholds exceed existing policy benchmarks, supporting further centralization of esophagogastric cancer surgery.