Skip to main content
Hauptrubriken
CME Facharzt-Training Webinare Zeitschriften Bücher e.Medpedia Podcast
Service
Jobbörse Info & Hilfe
Fachgebiete
Anästhesiologie Allgemeinmedizin Arbeitsmedizin Augenheilkunde Chirurgie Dermatologie Gynäkologie und Geburtshilfe HNO Innere Medizin Kardiologie Neurologie Onkologie und Hämatologie Orthopädie und Unfallchirurgie Pädiatrie Pathologie Psychiatrie Radiologie Rechtsmedizin Urologie Zahnmedizin
Themen
Typ-2-Diabetes und Adipositas Klimawandel und Gesundheit Neues aus dem Markt Praxis und Beruf Seltene Erkrankungen GOÄ & EBM
Sammlungen
Kasuistiken Algorithmen & Infografiken Blickdiagnosen Arthropedia FlapFinder (für Dermatochirurgen) Videos Kongressberichterstattung Medizin für Apothekerinnen und Apotheker Fachpsychotherapie Für Ärztinnen und Ärzte in Weiterbildung Für Medizinstudierende Patientenratgeber
Erweiterte Suche
Anmelden
nach oben
Surgery Today
Erschienen in:

18.11.2023 | Original Article

Impact of a board certification system and adherence to the clinical practice guidelines for gastric cancer on risk-adjusted surgical mortality after distal and total gastrectomy in Japan: a questionnaire survey of departments registered in the National Clinical Database

verfasst von: Hiroyuki Yamamoto, Atsushi Nashimoto, Isao Miyashiro, Hiroaki Miyata, Yasushi Toh, Mitsukazu Gotoh, Yasuhiro Kodera, Yoshihiro Kakeji, Yasuyuki Seto

Erschienen in: Surgery Today | Ausgabe 5/2024

Einloggen, um Zugang zu erhalten

Abstract

Purpose

The relationship between board certification, clinical guideline implementation, and quality of gastric cancer surgery remains unclear.

Methods

A web-based questionnaire survey was administered to departments registered in the National Clinical Database (NCD) of Japan between October 2014 and January 2015. Quality indicators (QIs) based on the Donabedian model were evaluated. Structural QIs (e.g., affiliations with academic societies and board certifications) and process QIs (adherence to clinical practice guidelines for gastric cancer) were assessed using risk-adjusted odds ratios (AORs) for surgical mortality. Multivariable logistic regression models with a generalized estimating equation were used.

Results

A total of 835 departments performing 40,992 distal gastrectomies and 806 departments performing 19,618 total gastrectomies responded. Some certified institutions and physicians showed significant associations, with lower AORs for surgical mortality. Important process QIs included pre- and postoperative abdominal CT scanning, endoscopic resection based on progression, curative resection with D2 dissection for advanced gastric cancer, laparoscopic surgery, and HER2 testing for patients with unresectable recurrent gastric cancer.

Conclusions

Multiple structural and process QIs are associated with surgical mortality after gastrectomy in Japan. Measuring and visualizing QIs may enhance healthcare improvements.
Literatur
1.
2.
Fukao A, Tsubono Y, Tsuji I, Isamichi SH, Sugahara N, Takano A. The evaluation of screening for gastric cancer in Miyagi prefecture, Japan: a population-based case-control study. Int J Cancer. 1995;60:45–8.CrossRefPubMed
3.
4.
Terashima M. The 140 years’ journey of gastric cancer surgery: from the two hands of Billroth to the multiple hands of the robot. Ann Gastroenterol Surg. 2021;5:270–7.CrossRefPubMedPubMedCentral
5.
Mrena J, Mattila A, Böhm J, Jantunen I, Kellokumpu I. Surgical care quality and oncologic outcome after D2 gastrectomy for gastric cancer. World J Gastroenterol. 2015;21:13294–301.CrossRefPubMedPubMedCentral
6.
Morgan JW, Ji L, Friedman G, Senthil M, Dyke C, Lum SS. The role of the cancer center when using lymph node count as a quality measure for gastric cancer surgery. JAMA Surg. 2015;150:37–43.CrossRefPubMed
7.
Helyer LK, O’Brien C, Coburn NG, Swallow CJ. Surgeons’ knowledge of quality indicators for gastric cancer surgery. Gastric Cancer. 2007;10:205–14.CrossRefPubMed
8.
Ito Y, Miyashiro I, Ishikawa T, Akazawa K, Fukui K, Katai H, et al. Determinant factors on differences in survival for gastric cancer between the United States and Japan using nationwide databases. J Epidemiol. 2021;31:241–8.CrossRefPubMedPubMedCentral
9.
Sano T, Aiko T. New Japanese classifications and treatment guidelines for gastric cancer: revision concepts and major revised points. Gastric Cancer. 2011;14:97–100.CrossRefPubMed
10.
Suda K, Yamamoto H, Nishigori T, Obama K, Yoda Y, Hikage M, et al. Safe implementation of robotic gastrectomy for gastric cancer under the requirements for universal health insurance coverage: a retrospective cohort study using a nationwide registry database in Japan. Gastric Cancer. 2022;25:438–49.CrossRefPubMed
11.
Miyata H, Gotoh M, Hashimoto H, Motomura N, Murakami A, Tomotaki A, et al. Challenges and prospects of a clinical database linked to the board certification system. Surg Today. 2014;44:1991–9.CrossRefPubMed
12.
Gotoh M, Miyata H, Hashimoto H, Wakabayashi G, Konno H, Miyakawa S, et al. National clinical database feedback implementation for quality improvement of cancer treatment in Japan: from good to great through transparency. Surg Today. 2016;46:38–47.CrossRefPubMed
13.
Anazawa T, Paruch JL, Miyata H, Gotoh M, Ko CY, Cohen ME, et al. Comparison of national operative mortality in gastroenterological surgery using web-based prospective data entry systems. Medicine (Baltimore). 2015;94: e2194.CrossRefPubMedPubMedCentral
14.
Kurita N, Miyata H, Gotoh M, Shimada M, Imura S, Kimura W, et al. Risk model for distal gastrectomy when treating gastric cancer on the basis of data from 33,917 Japanese patients collected using a nationwide web-based data entry system. Ann Surg. 2015;262:295–303.CrossRefPubMed
15.
Kunisaki C, Miyata H, Konno H, Saze Z, Hirahara N, Kikuchi H, et al. Modeling preoperative risk factors for potentially lethal morbidities using a nationwide Japanese web-based database of patients undergoing distal gastrectomy for gastric cancer. Gastric Cancer. 2017;20:496–507.CrossRefPubMed
16.
Watanabe M, Miyata H, Gotoh M, Baba H, Kimura W, Tomita N, et al. Total gastrectomy risk model: data from 20,011 Japanese patients in a nationwide internet-based database. Ann Surg. 2014;260:1034–9.CrossRefPubMed
17.
Kikuchi H, Miyata H, Konno H, Kamiya K, Tomotaki A, Gotoh M, et al. Development and external validation of preoperative risk models for operative morbidities after total gastrectomy using a Japanese web-based nationwide registry. Gastric Cancer. 2017;20:987–97.CrossRefPubMedPubMedCentral
18.
Kakeji Y, Yamamoto H, Ueno H, Eguchi S, Endo I, Sasaki A, et al. Development of gastroenterological surgery over the last decade in Japan: analysis of the national clinical database. Surg Today. 2021;51:187–93.CrossRefPubMed
19.
Iwatsuki M, Yamamoto H, Miyata H, Kakeji Y, Yoshida K, Konno H, et al. Effect of hospital and surgeon volume on postoperative outcomes after distal gastrectomy for gastric cancer based on data from 145,523 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer. 2019;22:190–201.CrossRefPubMed
20.
Iwatsuki M, Yamamoto H, Miyata H, Kakeji Y, Yoshida K, Konno H, et al. Association of surgeon and hospital volume with postoperative mortality after total gastrectomy for gastric cancer: data from 71,307 Japanese patients collected from a nationwide web-based data entry system. Gastric Cancer. 2021;24:526–34.CrossRefPubMed
21.
Claassen YHM, Van Sandick JW, Hartgrink HH, Dikken JL, De Steur WO, Van Grieken NCT, et al. Association between hospital volume and quality of gastric cancer surgery in the CRITICS trial. Br J Surg. 2018;105:728–35.CrossRefPubMed
22.
Dikken JL, Dassen AE, Lemmens VE, Putter H, Krijnen P, Van Der Geest L, et al. Effect of hospital volume on postoperative mortality and survival after oesophageal and gastric cancer surgery in the Netherlands between 1989 and 2009. Eur J Cancer. 2012;48:1004–13.CrossRefPubMed
23.
Boudourakis LD, Wang TS, Roman SA, Desai R, Sosa JA. Evolution of the surgeon-volume, patient-outcome relationship. Ann Surg. 2009;250:159–65.CrossRefPubMed
24.
25.
Higashi T, Nakamura F, Shimada Y, Shinkai T, Muranaka T, Kamiike W, et al. Quality of gastric cancer care in designated cancer care hospitals in Japan. Int J Qual Health Care. 2013;25:418–28.CrossRefPubMed
26.
Ryu M, Hamano M, Nakagawara A, Shinoda M, Shimizu H, Miura T, et al. The benchmark analysis of gastric, colorectal and rectal cancer pathways: toward establishing standardized clinical pathway in the cancer care. Jpn J Clin Oncol. 2011;41:2–9.CrossRefPubMed
27.
28.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2010 (ver.3). Gastric Cancer. 2011;14:113–23.CrossRef
29.
Bang YJ, Van Cutsem E, Feyereislova A, Chung HC, Shen L, Sawaki A, et al. Trastuzumab in combination with chemotherapy versus chemotherapy alone for treatment of HER2-positive advanced gastric or gastro-oesophageal junction cancer (ToGA): a phase 3, open-label, randomised controlled trial. Lancet. 2010;376:687–97.CrossRefPubMed
30.
Japanese Gastric Cancer Association. Japanese gastric cancer treatment guidelines 2014 (ver. 4). Gastric Cancer. 2017;20:1–19.CrossRef
31.
Mizushima T, Yamamoto H, Marubashi S, Kamiya K, Wakabayashi G, Miyata H, et al. Validity and significance of 30-day mortality rate as a quality indicator for gastrointestinal cancer surgeries. Ann Gastroenterol Surg. 2018;2:231–40.CrossRefPubMedPubMedCentral
32.
Konno H, Kamiya K, Kikuchi H, Miyata H, Hirahara N, Gotoh M, et al. Association between the participation of board-certified surgeons in gastroenterological surgery and operative mortality after eight gastroenterological procedures. Surg Today. 2017;47:611–8.CrossRefPubMed
33.
Toh Y, Yamamoto H, Miyata H, Gotoh M, Watanabe M, Matsubara H, et al. Significance of the board-certified surgeon systems and clinical practice guideline adherence to surgical treatment of esophageal cancer in Japan: a questionnaire survey of departments registered in the national clinical database. Esophagus. 2019;16:362–70.CrossRefPubMedPubMedCentral
34.
Arita J, Yamamoto H, Kokudo T, Hasegawa K, Miyata H, Toh Y, et al. Impact of board certification system and adherence to the clinical practice guidelines for liver cancer on post-hepatectomy risk-adjusted mortality rate in Japan: a questionnaire survey of departments registered with the national clinical database. J Hepatobiliary Pancreat Sci. 2021;28:801–11.CrossRefPubMedPubMedCentral
35.
Mizuma M, Yamamoto H, Miyata H, Gotoh M, Unno M, Shimosegawa T, et al. Impact of a board certification system and implementation of clinical practice guidelines for pancreatic cancer on mortality of pancreaticoduodenectomy. Surg Today. 2020;50:1297–307.CrossRefPubMedPubMedCentral
36.
Kobayashi H, Yamamoto H, Miyata H, Gotoh M, Kotake K, Sugihara K, et al. Impact of adherence to board-certified surgeon systems and clinical practice guidelines on colon cancer surgical outcomes in Japan: a questionnaire survey of the national clinical database. Ann Gastroenterol Surg. 2020;4:283–93.CrossRefPubMedPubMedCentral
37.
Huscher CG, Mingoli A, Sgarzini G, Sansonetti A, Di Paola M, Recher A, et al. Laparoscopic versus open subtotal gastrectomy for distal gastric cancer: five-year results of a randomized prospective trial. Ann Surg. 2005;241:232–7.CrossRefPubMedPubMedCentral
38.
Marubashi S, Takahashi A, Kakeji Y, Hasegawa H, Ueno H, Eguchi S, et al. Surgical outcomes in gastroenterological surgery in Japan: report of the national clinical database 2011–2019. Ann Gastroenterol Surg. 2021;5:639–58.CrossRefPubMedPubMedCentral
39.
Sakuramoto S, Sasako M, Yamaguchi T, Kinoshita T, Fujii M, Nashimoto A, et al. Adjuvant chemotherapy for gastric cancer with S-1, an oral fluoropyrimidine. N Engl J Med. 2007;357:1810–20.CrossRefPubMed
Metadaten
Titel
Impact of a board certification system and adherence to the clinical practice guidelines for gastric cancer on risk-adjusted surgical mortality after distal and total gastrectomy in Japan: a questionnaire survey of departments registered in the National Clinical Database
verfasst von
Hiroyuki Yamamoto
Atsushi Nashimoto
Isao Miyashiro
Hiroaki Miyata
Yasushi Toh
Mitsukazu Gotoh
Yasuhiro Kodera
Yoshihiro Kakeji
Yasuyuki Seto
Publikationsdatum
18.11.2023
Verlag
Springer Nature Singapore
Erschienen in
Surgery Today / Ausgabe 5/2024
Print ISSN: 0941-1291
Elektronische ISSN: 1436-2813
DOI
https://doi.org/10.1007/s00595-023-02753-2

Weitere Artikel der Ausgabe 5/2024

Clinical outcome and neurological development of patients with biliary atresia associated with a bleeding tendency: a single institution experience

  • Original Article

The urinary and sexual outcomes of robot-assisted versus laparoscopic rectal cancer surgery: a systematic review and meta-analysis

  • Review Article

Dynamics of perioperative pancreatic exocrine function in patients undergoing reconstruction after gastrectomy for gastric cancer

  • Original Article

The effect of a low preoperative albumin level on the long-term mortality: a meta-regression analysis

  • Letter to the Editor

Influence of surgical volume on the mortality and morbidity of gastrointestinal perforation in children

  • Original Article

Simulation to determine the approach of transcatheter aortic valve implantation in patients undergoing hemodialysis

  • Open Access
  • Original Article

Neu im Fachgebiet Chirurgie

Appendektomie erhält Remission bei Colitis ulcerosa

Wird der Wurmfortsatz bei Personen mit Colitis ulcerosa entfernt, ist die Rückfallrate um ein Drittel geringer als unter konservativer Behandlung. Auch die Lebensqualität verbessert sich und der Bedarf an Medikamenten nimmt ab.

Op.-Entscheidung bei Divertikulitis: Lebensqualität zählt!

Soll man Menschen, die schon mehrfach schmerzhafte Divertikulitisepisoden durchgemacht haben, eine Op. anbieten? Ein Team aus Helsinki rät, dies von der Lebensqualität abhängig zu machen.

Akute Cholezystitis bei multimorbiden Älteren: Operation nicht sofort ausschließen!

Bei älteren, multimorbiden Menschen mit akuter Cholezystitis wird eine Operation häufig nicht erwogen. Eine Studie aus Philadelphia zeigt nun jedoch, dass auch diese Patientinnen und Patienten von einer chirurgischen Therapie profitieren können.

Was geschehen muss, damit Prähabilitation in die Leitlinien kommt

Eine Prähabilitation vor einem viszeralchirurgischen Eingriff ist Experten zufolge äußerst sinnvoll, dennoch wird sie in Leitlinien derzeit nicht empfohlen. Beim DCK erklärte Prof. Tim Vilz aus Bonn, woran das liegt und was benötigt wird, um die Situation zu ändern.

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

Newsletter bestellen
Bildnachweise