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Quality of Care Indicators for the Surgical Treatment of Gastric Cancer: A Systematic Review

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Quality assurance is increasingly acknowledged as a crucial factor for the (surgical) treatment of gastric cancer. The purpose of the current study was to define a minimum set of evidence-based quality of care indicators for the surgical treatment of locally advanced gastric cancer.

Methods

A systematic review of the literature published between January 1990 and May 2011 was performed, using search terms on gastric cancer, treatment, and quality of care. Studies were selected based on predefined selection criteria. Potential quality of care indicators were assessed based on their level of evidence and were grouped into structure, process, and outcome indicators.

Results

A total of 173 articles were included in the current study. For structural measures, evidence was found for the inverse relationship between hospital volume and postoperative mortality as well as overall survival. Regarding process measures, the most common indicators concerned surgical technique, perioperative care, and multimodality treatment. The only outcome indicator with supporting evidence was a microscopically radical resection.

Conclusions

Although specific literature on quality of care indicators for the surgical treatment of locally advanced gastric cancer is limited, several quality of care indicators could be identified. These indicators can be used in clinical audits and other quality assurance programs.

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Acknowledgment

The authors thank Josepha Plevier as the specialized librarian who helped to perform a systematic search of the available literature. This research was funded by the Dutch Cancer Society (KWF kankerbestrijding) and the Stichting Cornelis Vrolijk Development Fund.

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Authors and Affiliations

  1. Department of Surgery, Leiden University Medical Center, Leiden, The Netherlands

    Johan L. Dikken MD, PhD, Cornelis J. H. van de Velde MD, PhD & Michel W. J. M. Wouters MD

  2. Department of Radiotherapy, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Johan L. Dikken MD, PhD & Marcel Verheij MD, PhD

  3. Department of Surgical Oncology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Jurriën Stiekema MD, Michel W. J. M. Wouters MD & Johanna W. van Sandick MD, PhD

  4. Department of Gastroenterology, The Netherlands Cancer Institute/Antoni van Leeuwenhoek Hospital, Amsterdam, The Netherlands

    Annemieke Cats MD, PhD

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  1. Johan L. Dikken MD, PhD
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Johan L. Dikken and Jurriën Stiekema contributed equally to the preparation of this manuscript.

Appendix: PubMed and Embase search terms

Appendix: PubMed and Embase search terms

PubMed

Limits activated: English, Publication Date from 1990

(“stomach neoplasms”[mesh] OR (stomach[All Fields] OR gastric[all fields]) AND (neoplasms[all Fields] OR neoplasm[all fields] OR tumor[all fields] OR tumors[all fields] OR tumor[all fields] OR tumors[all fields] OR cancer[all fields] OR cancers[all fields] OR carcinoma[all fields] OR carcinomas[all fields])))

AND

(“gastrectomy”[mesh] OR “gastrectomy”[all fields] OR “gastrectomies”[all fields] OR “gastric resection”[all fields] OR “Stomach Neoplasms/surgery”[mesh] OR “Lymph Node Excision”[mesh] OR “Surgical Procedures, Operative”[mesh:noexp] OR “Neoadjuvant Therapy”[mesh] OR “Chemotherapy, Adjuvant”[mesh] OR “Radiotherapy, Adjuvant”[mesh] OR adjuvant[tiab] OR neoadjuvant[tiab])

AND

(“quality indicators, health care”[mesh] OR (“quality”[all fields] AND (“indicators”[all fields] OR indicator[all fields])) OR “health care quality indicators”[all fields] OR “Quality Assurance, Health Care”[mesh] OR “health care quality assessment”[all fields] OR “benchmarking”[mesh] OR “benchmarking”[all fields] OR “Outcome and Process Assessment (Health Care)”[mesh:noexp] OR “outcome assessment”[all fields] OR “Process Assessment”[all fields] OR “Delivery of Health Care”[mesh] OR “Risk Adjustment”[mesh] OR “risk adjustment”[all fields] OR “Clinical Audit”[mesh] OR “audit”[all fields] OR “Quality of Health Care”[mesh:noexp] OR “Quality Control”[mesh] OR “Guideline Adherence”[mesh] OR “Clinical Competence”[mesh] OR “Hospital Mortality”[mesh] OR “Mortality”[mesh:noexp] OR “Mortality”[ti] OR “Morbidity”[mesh:noexp] OR “Postoperative Complications”[mesh] OR “Complications” [ti] OR “Treatment Outcome”[mesh])

NOT

((animals[mesh] NOT humans[mesh]))

Embase

Limits activated: English, Publication Date from 1990

(exp *”stomach tumor”/ OR ((stomach.ti. OR gastric.ti.) AND (neoplasms.mp. OR neoplasm.mp. OR tumor.mp. OR tumors.mp. OR tumor.mp. OR tumors.mp. OR cancer.mp. OR cancers.mp. OR carcinoma.mp. OR carcinomas.mp.)))

AND

(exp *gastrectomy/ OR “gastrectomy”.mp. OR “gastrectomies”.mp. OR “gastric resection”.mp. OR exp *stomach tumor/su OR “Lymph Node Excision”.mp. OR exp *lymphadenectomy/ OR *surgery/ OR surgical.mp. OR adjuvant.ti,ab. OR exp *ADJUVANT CHEMOTHERAPY/ OR neoadjuvant.ti,ab. OR exp *adjuvant therapy/)

AND

(exp *health care quality/ OR (quality.ti,ab. AND indicators*.ti,ab.) OR “quality assurance”.ti,ab. OR exp *quality control/ OR “health care quality assessment”.ti,ab. OR benchmark*.ti,ab. OR exp *outcome assessment/ OR “outcome assessment”.ti,ab. OR “Process Assessment”.ti,ab. OR “delivery of health care”.ti,ab. OR exp *health care delivery/ OR exp *risk assessment/ OR “risk adjustment”.ti,ab. OR exp *medical audit/ OR “audit”.ti,ab. OR “health care quality access evaluation”.ti,ab. OR exp *health care access/ OR exp *”evaluation and follow up”/ OR exp *clinical assessment/ OR exp *clinical evaluation/ OR exp *evaluation/ OR exp *evaluation research/ OR exp *outcome assessment/ OR “quality control”.ti,ab. OR exp *quality control/ OR “guideline adherence”.ti,ab. OR “guidelines as topic”.ti,ab. OR “clinical coti,abetence”.ti,ab. OR exp *clinical competence/ OR “hospital mortality”.ti,ab. OR *mortality/ OR morbidity.ti,ab. OR *morbidity/ OR complication*.ti,ab. OR exp *postoperative complication/ OR treatment outcome.ti,ab. OR exp *treatment outcome/)

AND

(exp human/)

Cochrane Library

Limits activated: English, Publication Date from 1990

“stomach neoplasms”

AND

(gastrectomy OR “lymph node excision” OR adjuvant OR neoadjuvant)

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Dikken, J.L., Stiekema, J., van de Velde, C.J.H. et al. Quality of Care Indicators for the Surgical Treatment of Gastric Cancer: A Systematic Review. Ann Surg Oncol 20, 381–398 (2013). https://doi.org/10.1245/s10434-012-2574-1

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