Evidence map›Paper›PMID 41528662›Full record

ArticleGastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association2026

Hospital variation in surgical outcomes for gastric cancer: the impact of case-mix and treatment across a global cohort.

Sander J M van Hootegem, Margrietha van der Linde, Marcel A Schneider, Jeesun Kim, Felix Berlth, Yutaka Sugita, Peter P Grimminger, Gian Luca Baiocchi, Giovanni De Manzoni, Maria Bencivenga and 8 more

Abstract readMulticenter Study
PubMed Full text at PMC Publisher
In one paragraph

Article in Gastric cancer : official journal of the International Gastric Cancer Association and the Japanese Gastric Cancer Association, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Cited by 1 paper.

0numbers the graph read from it
0cells of the map it votes in
1citing papers in PubMed
–field-weighted citation impact
1 · What the graph read from it

What it found

Each row is one number read from the abstract, on the scale the paper reported it, with its interval. Left of the dashed line favours the treatment, right favours the comparator. Under each row is the sentence it came from. New to these charts? A ten-minute tutorial.

The abstract states no effect estimate the extractor could read, or names no intervention and outcome on the map, so this paper lights no cell and moves no belief. It is still indexed, cited and linked below.

2 · The registry

The trial behind it

Trials whose registry record cites this paper, or whose number appears in the abstract. A trial that started after this paper was published is citing it as background, not reporting it.

Neither the registry nor the abstract names a trial number. If this is a trial report, that itself is worth knowing.

3 · Its place in the literature

Who cites it

1 citing paper in PubMed.

  1. Article
4 · The record

Corrections and comments

PubMed lists nothing against this paper. Absence here is not a guarantee, only a check that was made.

5 · Who and what money

Authors and funding

18 authors.

Sander J M van HootegemDepartment of Surgery, Erasmus Medical Center, University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands. s.vanhootegem@erasmusmc.nl.
Margrietha van der LindeDepartment of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Marcel A SchneiderDepartment of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
Jeesun KimDepartment of Surgery, Seoul National University Cancer Hospital, Seoul, South Korea.
Felix BerlthDepartment of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
Yutaka SugitaDepartment of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Peter P GrimmingerDepartment of General-, Visceral- and Transplant Surgery, University Medical Center Mainz, Mainz, Germany.
Gian Luca BaiocchiDepartment of Clinical and Experimental Sciences, University of Brescia, Brescia, Italy.
Giovanni De ManzoniDepartment of Surgery, University Hospital of Verona, Verona, Italy.
Maria BencivengaDepartment of Surgery, University Hospital of Verona, Verona, Italy.
Suzanne S GisbertzDepartment of Surgery, Amsterdam UMC location University of Amsterdam, Amsterdam, The Netherlands.
Souya NunobeDepartment of Gastroenterological Surgery, Cancer Institute Hospital of the Japanese Foundation for Cancer Research, Tokyo, Japan.
Han-Kwang YangDepartment of Surgery, Seoul National University Cancer Hospital, Seoul, South Korea.
Christian A GutschowDepartment of Surgery and Transplantation, University Hospital Zürich, Zürich, Switzerland.
Sjoerd M LagardeDepartment of Surgery, Erasmus Medical Center, University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands.
Hester F LingsmaDepartment of Public Health, Erasmus Medical Center, Rotterdam, The Netherlands.
Bas P L WijnhovenDepartment of Surgery, Erasmus Medical Center, University Medical Center, P.O. Box 2040, 3000CA, Rotterdam, The Netherlands.
GastroBenchmark & GASTRODATA consortiums

Funding

No grant is acknowledged in the PubMed record.

6 · The paper itself

Abstract

backgroundThere is substantial global variation in demographics, disease burden, and treatment for gastric cancer patients. Benchmarking is an instrument to assess such variation and enables to investigate to which extent case-mix and treatments explain differences in outcomes. We aimed to evaluate hospital-level variation in surgical outcomes following gastrectomy for gastric cancer before and after adjusting for case-mix and treatment-related factors.

methodsData were retrieved from the GastroBenchmark and GASTRODATA databases, including consecutive gastric cancer resections performed between 2017 and 2021 from 43 centers. Patients who underwent a (sub)total gastrectomy for adenocarcinoma were identified. Outcomes included 30-day mortality, severe complications (Clavien-Dindo grade ≥ 3a), > 15 lymph nodes retrieved, negative resection margin (R0), prolonged hospitalization (> 14 days), readmissions (< 30 days), reoperations, and escalation of care. We assessed absolute inter-hospital variation for outcomes, and estimated outcomes using mixed-effect logistic regression models with a random intercept. We estimated crude, case-mix adjusted, and case-mix and treatment adjusted hospital effects. The conditional and marginal pseudo-R

resultsA total of 7818 patients from 41 hospitals were included, with contributions ranging from 12 to 2554 patients per hospital (IQR: 49-146). Observed 30-day mortality and severe complications ranged from 0 to 9.7% (IQR: 3.2%) and 5.3 to 31% (IQR: 7.7%), respectively. Larger variation between hospitals was observed for retrieval of > 15 lymph nodes (IQR: 12.3%), prolonged hospitalization (IQR: 14.4%) and readmissions (IQR 11.3%). This variation was reduced in the crude model, while adjusting for case-mix and treatment-related factors did not significantly reduce variation for any outcome. Case-mix factors had a limited contribution to the explained variance, except for 30-day mortality (33.9%) and negative resection margins (31.7%). Adding treatment-related factors increased the explained variance for 30-day mortality by 40.8%, but had low impact (< 10%) on the variance in most surgical outcomes.

conclusionsCase-mix and treatment factors are not the primary drivers of variation in surgical outcomes following gastrectomy. Case-mix adjustment can improve the validity of global comparisons for 30-day mortality, but does not seem essential for comparing other investigated outcomes.

Indexed as

AdenocarcinomaGastrectomyHospitalsPostoperative ComplicationsStomach NeoplasmsAgedDiagnosis-Related GroupsFemaleHumansMaleMiddle AgedTreatment OutcomeGastrectomyQuality of health careStomach neoplasmsTreatment outcome

Identifiers

PMID41528662
PMCPMC12957621

What Socratic holds

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Registered trials

None linked

Read under generation 80e0d062 · epoch 390. Bibliography from PubMed, PubMed Central and OpenAlex; grants from NIH RePORTER; trial links from ClinicalTrials.gov; estimates, votes and beliefs from the Socratic graph.