Association between surgical volumes and postoperative outcomes after gastric cancer resection
- 1Department of General, Visceral, Endocrine and Transplant Surgery, HOCH - Cantonal Hospital of St. Gallen, Rorschacherstrasse 95, St. Gallen, CH-9007 Switzerland
Abstract
Background: The association between hospital volume and outcomes after gastric cancer resection remains controversial. This Swiss national registry study investigated the association between annual hospital-volume for gastric cancer resection and short-term outcomes.
Methods: This retrospective population-based study included adult patients undergoing elective gastric cancer resection in Switzerland between 2013 and 2022. Annual hospital volume was defined as the number of gastric cancer resections performed at the treating hospital in the calendar year of surgery. The primary endpoint was in-hospital mortality. Secondary endpoints were postoperative complications, failure to rescue (FTR), reoperation, and length of hospital stay (LOS). Generalized additive regression models (GAM), standardized mortality ratios (SMR), quantile regression, and trend tests were used to assess the association with hospital volume.
Results: Among 3,861 gastric cancer resections, in-hospital mortality was 3.1%, complications occurred in 48.0%, and mean LOS was 17.1 days. Higher annual hospital volume was associated with lower mortality rates (odds ratio per 10 additional resections (OR): 0.769, 95% confidence interval (CI) 0.617–0.957; p = 0.019) and FTR (OR: 0.727, 95% CI: 0.581–0.910; p = 0.005), but with higher complication rates (OR: 1.104, CI: 1.027–1.185; p = 0.007). The very-high-volume quintile (22–39 resections/year) had the lowest mortality rate (1.4%), despite the highest comorbidity burden and complication rate. Gastric cancer resection volume was associated with SMR (p < 0.001). No significant overall association between hospital volume and LOS was observed. During the study period, mortality and FTR decreased, while annual hospital volume increased.
Conclusion: In this Swiss cohort, higher annual gastric cancer resection volume was associated with lower in-hospital mortality and FTR rates. The lower mortality observed in higher-volume hospitals occurred despite a greater comorbidity burden and higher recorded complication rates, suggesting that differences in the response to postoperative complications may contribute to the observed volume–outcome relationship.
Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13037-026-00505-y.
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BibTeX
@article{klein2026association,
title = {{Association between surgical volumes and postoperative outcomes after gastric cancer resection}},
author = {Marie Klein and Rene Warschkow and Yanic Ammann and Kristijan Ukegjini and Patrick Folie and Bruno Schmied and Ignazio Tarantino},
journal = {Patient Safety in Surgery},
year = {2026},
month = aug,
doi = {10.1186/s13037-026-00505-y},
url = {https://doi.org/10.1186/s13037-026-00505-y},
note = {CC BY 4.0},
}
RIS
TY - JOUR
TI - Association between surgical volumes and postoperative outcomes after gastric cancer resection
AU - Marie Klein
AU - Rene Warschkow
AU - Yanic Ammann
AU - Kristijan Ukegjini
AU - Patrick Folie
AU - Bruno Schmied
AU - Ignazio Tarantino
PY - 2026
DA - 2026/08/04
JO - Patient Safety in Surgery
DO - 10.1186/s13037-026-00505-y
UR - https://doi.org/10.1186/s13037-026-00505-y
AB - Background: The association between hospital volume and outcomes after gastric cancer resection remains controversial. This Swiss national registry study investigated the association between annual hospital-volume for gastric cancer resection and short-term outcomes. Methods: This retrospective population-based study included adult patients undergoing elective gastric cancer resection in Switzerland between 2013 and 2022. Annual hospital volume was defined as the number of gastric cancer resections performed at the treating hospital in the calendar year of surgery. The primary endpoint was in-hospital mortality. Secondary endpoints were postoperative complications, failure to rescue (FTR), reoperation, and length of hospital stay (LOS). Generalized additive regression models (GAM), standardized mortality ratios (SMR), quantile regression, and trend tests were used to assess the association with hospital volume. Results: Among 3,861 gastric cancer resections, in-hospital mortality was 3.1%, complications occurred in 48.0%, and mean LOS was 17.1 days. Higher annual hospital volume was associated with lower mortality rates (odds ratio per 10 additional resections (OR): 0.769, 95% confidence interval (CI) 0.617–0.957; p = 0.019) and FTR (OR: 0.727, 95% CI: 0.581–0.910; p = 0.005), but with higher complication rates (OR: 1.104, CI: 1.027–1.185; p = 0.007). The very-high-volume quintile (22–39 resections/year) had the lowest mortality rate (1.4%), despite the highest comorbidity burden and complication rate. Gastric cancer resection volume was associated with SMR (p < 0.001). No significant overall association between hospital volume and LOS was observed. During the study period, mortality and FTR decreased, while annual hospital volume increased. Conclusion: In this Swiss cohort, higher annual gastric cancer resection volume was associated with lower in-hospital mortality and FTR rates. The lower mortality observed in higher-volume hospitals occurred despite a greater comorbidity burden and higher recorded complication rates, suggesting that differences in the response to postoperative complications may contribute to the observed volume–outcome relationship. Supplementary Information: The online version contains supplementary material available at https://doi.org/10.1186/s13037-026-00505-y.
SN - 1754-9493
ER -