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Survival, mortality and morbidity outcomes after oesophagogastric cancer surgery in New South Wales, 2001–2008

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In reply: International evidence of high-volume institutions having better outcomes for complex cancer surgery is strong.1,2 Our analyses confirm the direction and magnitude of this relationship in New South Wales. Should we ignore the international evidence?

Our analyses showed improved 5-year survival for people with oesophagogastric cancer who received surgery in a higher-volume hospital. The difference in survival was not explained by the age, comorbidity, extent of disease or urgency of admission. We used hospital volume as a measure of hospital experience in the surgical and non-surgical management of oesophagogastric cancer patients. More accurate staging and more effective delivery of adjuvant therapy may be part of the reason for the volume–outcome relationships observed. Patient outcomes are determined by more than what happens on the operating table. This is not about the surgeon but about performing complex procedures frequently enough in institutions able to provide the range of diagnostics, perioperative support services, multidisciplinary care and expertise that surgeons require and patients need for great outcomes.3,4 Can anyone defend institutions performing these procedures at a low volume?