| Xirasagar S |
------>authors3_c= ------>paper_class1=1 ------>Impact_Factor=1.873 ------>paper_class3=2 ------>paper_class2=1 ------>vol= ------>confirm_bywho=nwkuo ------>insert_bywho=henry11111 ------>Jurnal_Rank=66.1 ------>authors4_c= ------>comm_author=1 ------>patent_EDate=None ------>authors5_c= ------>publish_day=1 ------>paper_class2Letter=None ------>page2= ------>medlineContent= ------>unit=E0800 ------>insert_date=20070730 ------>iam=3 ------>update_date=None ------>author=??? ------>change_event=4 ------>ISSN= ------>authors_c= ------>score=312 ------>journal_name=EJSO - The Journal of Cancer Surgery (in press) ------>paper_name=Procedure Volume of Gastric Cancer Resections versus 5-year Survival: Does Hospital or Surgeon Volume Matter ------>confirm_date=20071114 ------>tch_id=090053 ------>pmid=17890043 ------>page1= ------>fullAbstract=AIM: We used nationwide, population-based data to examine associations between hospital and surgeon volumes of gastric cancer resections and their patients~ short-term and long-term survival likelihood. METHODS: The study uses 1997-1999 inpatient claims data from Taiwan~s National Health Insurance linked to "cause of death" data for 1997-2004. The total cohort of 6909 gastric cancer resection patients were categorized by their surgeon~s/hospital~s procedure volume, and examined for differences in 6-month mortality and 5-year mortality (post 6 months), by procedure volume, using Cox proportional hazard regressions, adjusting for surgeon, hospital and patient characteristics. We hypothesized that surgeons~ case volume and age but not hospital volume will predict short-term and long-term survival. RESULTS: Adjusted estimates show that increasing surgeon volume predicts better 6-month survival (adjusted mortality hazard ratio = 1.3 for low-volume surgeons relative to very high-volume surgeons; p < 0.01) and 5-year survival (adjusted mortality hazard ratios = 1.3; p < 0.001 for low-volume; 1.2 with p < 0.01 for medium volume) and increasing surgeon~s age (adjusted hazards ratio = 1.4 for age < 41 years relative to 41-50 years; p < or = 0.001; 0.8 for > or = 51 years relative to 41-50 years; p < 0.05). In hospital volume regressions, surgeon~s age is a consistent and significant predictor, not hospital volume. Findings suggest a key role of experience in surgical skill and sensitivity for early stage diagnosis in gastric cancer survival. CONCLUSIONS: Although a key study limitation is the lack of cancer stage data, the pattern of findings suggests that experienced surgeons have relatively better survival outcomes among gastric cancer patients. ------>tmu_sno=None ------>sno=15902 ------>authors2=Lien YC ------>authors3=Lin HC ------>authors4=Lee HC ------>authors5=Liu TC ------>authors6=Tsai J ------>authors6_c= ------>authors=Xirasagar S ------>delete_flag=0 ------>SCI_JNo=None ------>authors2_c= ------>publish_area=0 ------>updateTitle=Procedure volume of gastric cancer resections versus 5-year survival. ------>language=2 ------>check_flag=None ------>submit_date=None ------>country=None ------>no= ------>patent_SDate=None ------>update_bywho=None ------>publish_year=2007 ------>submit_flag=None ------>publish_month=1 |