Safety outcomes of endoscopic submucosal dissection (ESD) differ according to the number of ESDs performed at the operating center, according to results of a study presented at the 2023 ASCO Gastrointestinal Cancers Symposium.
Patients with gastric cancer or dysplasia who underwent ESD at very low-volume centers had a higher risk of adverse outcomes, including bleeding, perforation, pneumonia, and death, said study presenter Jae Gyu Kim, MD, PhD, of Chung-Ang University College of Medicine in Seoul, South Korea.
Dr Kim and colleagues conducted this study using data from the Korean National Health Insurance Service database. The researchers evaluated outcomes of 89,780 patients who underwent ESD for gastric cancer or dysplasia from November 2011 to December 2017.
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Hospitals were stratified by number of ESDs performed per year. They were divided into very low-volume centers (<10 ESDs per year; 1.8%), low-volume centers (lower third of the remaining hospitals; 32.2%), high-volume centers (middle third of the remaining hospitals; 32.0%), and very high-volume centers (upper third of the remaining hospitals; 34.0%).
Two-thirds of ESDs were performed in 13% of hospitals. The mean annual volume of ESDs at very low-volume centers was 4.1.
In general, patient age, sex, socioeconomic status, and co-medication use differed across the centers, and there was a positive relationship between Charlson comorbidity index and center volume (P <.001).
The researchers looked at the incidence of the following ESD-related complications: bleeding (5.3%), perforation (0.63%), pneumonia (0.75%), and 30-day mortality (0.06%). They also assessed these events together as a composite event (6.47%).
The incidence of individual events and the composite event was highest for patients treated at very low-volume centers, as seen in the table below.
|
Incidence of ESD-Related Complications by Center Volume |
|||||
|
Bleeding |
Perforation |
Pneumonia |
Death |
Composite |
|
|
Very low volume |
7.34% |
1.29% |
2.35% |
0.12% |
10.22% |
|
Low volume |
6.18% |
0.74% |
1.14% |
0.07% |
7.75% |
|
High volume |
4.54% |
0.85% |
0.66% |
0.04% |
5.75% |
|
Very high volume |
5.20% |
0.29% |
0.36% |
0.05% |
5.74% |
In a multivariable analysis, the risk for the composite outcome was lower at very high-volume centers (adjusted odds ratio [aOR], 0.485; 95% CI, 0.350-0.672; P <.001), high-volume centers (aOR, 0.461; 95% CI, 0.353-0.603; P <.001), and low-volume centers (aOR, 0.643; 95% CI, 0.518-0.800; P <.001), when compared with very low-volume centers.
When the researchers compared the high-volume and very high-volume centers, there was no significant difference in the composite outcome (aOR, 1.051; 95% CI, 0.761-1.452; P =.761).
Similar results were seen when the researchers assessed the risk of bleeding, perforation, and pneumonia individually. However, for bleeding, there was no significant difference between very high-volume centers and low-volume centers.
“The risk of adverse clinical outcome was significantly higher in very low-volume centers,” Dr Kim said. “So I’d like to propose that outcomes of gastric ESD should be closely and systematically monitored to ensure the safety of patients.”
Reference
Kim JG, Park JY, Kim BJ, Kim M-S. The influence of procedural volume on the outcome of endoscopic submucosal dissection for gastric neoplasm: A nationwide population-based study. ASCO GI 2023. January 19-21, 2023. Abstract 285.
