br References br Abbady A Assessment of the natural radioact
Abbady, A., 2005. Assessment of H 89 2HCl natural radioactivity and its radiological hazards in some Egyptian rock phosphate. Indian J. Pure Appl. Phys. 43, 489—493.
Beretka, J., Mathew, P.J., 1985. Natural radioactivity of Australian building materials, industrial wastes and by-products. J. Health Phys. 48, 87—95.
Eckerman, K.F., Wolbarst, A.B., Allan, C.B., 1989. Richardson Limit-ing Values of Radionuclide Intake and Air Concentration and Dose Conversion Factors For Inhalation, Submersion, and Ingestion. Federal Guidance Report No. 11. U.S. Environmental Protection Agency (EPA).
Flynn, A.M., Theodore, L., 2002. Health, Safety and Accident Man-agement in The Chemical Process Industries. Marcel Dekker, Inc., New York.
ICRP, 1990. Recommendations of the International Commission on Radiological Protection, vol. 21., pp. 1—3.
UNSCEAR, 1982. Report, Ionizing Radiation, Sources and Biological Effects, Report to the General Assembly, with Annex C.
UNSCEAR, 1993. Sources and Effects of Ionizing Radiation, Report to the General Assembly with Scientific Annexes. United Nations Publication.
UNSCEAR, 2000. Report, Sources and Effects of Ionizing Radiation, Volume I, Annex B, Exposures From Natural Radiation Sources.
UNSCEAR, 2008. Report, Sources and Effects of Ionizing Radiation, Volume I, Annex B, Exposures of the Public and Workers From Various Sources of Radiation. European Journal of Surgical Oncology xxx (xxxx) xxx
Contents lists available at ScienceDirect
European Journal of Surgical Oncology
Annual hospital volume of surgery for gastrointestinal cancer in relation to prognosis
Eivind Gottlieb-Vedi a, *, Fredrik Mattsson a, Pernilla Lagergren b, c, Jesper Lagergren a, d
a Upper Gastrointestinal Surgery, Department of Molecular Medicine & Surgery, Karolinska Institutet, Stockholm, Sweden
b Surgical Care Science, Department of Molecular Medicine and Surgery, Karolinska Institutet, Stockholm, Sweden
c Department of Surgery & Cancer, Imperial College London, London, United Kingdom
d School of Cancer & Pharmaceutical Sciences, King's College London, London, England, United Kingdom
Available online xxx
Background: Studies examining hospital volume for surgery for various gastrointestinal (GI) cancer types have shown conflicting results regarding the influence on long-term prognosis. The aim of DNA polymerase study was to examine annual hospital volume in relation to long-term survival after elective surgery for all GI cancers (esophagus, stomach, liver, pancreas, bile ducts, small bowel, colon, and rectum).
Methods: Population-based cohort study including all 45,908 patients who underwent elective surgery for GI cancers in Sweden in 2005e2013. Follow-up was until 2016 for disease-specific 5-year mortality (main outcome) and 2018 for all-cause 5-year mortality (secondary outcome). Hospitals were divided into quartiles for each GI cancer according to a 4-year average annual volume of the year of surgery and three years earlier. Multivariable Cox regression provided hazard ratios (HRs) with 95% confidence in-tervals (CIs), adjusted for relevant confounders.
Results: Higher hospital volume was associated with a survival benefit in the large group of patients (n ¼ 26,688) who underwent colon cancer resection, with HR 0.89 (95% CI 0.84e0.96) for disease-specific 5-year mortality comparing the highest with the lowest quartile. Higher hospital volume improved 5-year mortality in sub-groups of patients who underwent surgery for cancer of the esophagus, pancreas, and rectum. No such improvements were found for cancer of the stomach, liver, bile ducts, or small bowel.
Conclusion: Long-term survival was improved at higher volume hospitals for some GI cancers (colon, esophagus, pancreas, rectum), but not for others (stomach, liver, bile ducts, small bowel).
© 2019 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
Gastrointestinal cancers, including cancer of the esophagus, stomach, liver, pancreas, bile ducts, small bowel, colon and rectum, account for over 3.4 million deaths globally each year . The pri-mary curative treatment for gastrointestinal cancers is surgery, sometimes combined with chemotherapy or chemo-radiotherapy [2e8]. Research has consistently shown that short-term mortality after some gastrointestinal cancer procedures is lower at high-volume hospitals, especially for the most complex procedures such as esophagectomies and pancreatectomies [9,10], whereas this
* Corresponding author: Upper Gastrointestinal Surgery, NS 67, Department of Molecular medicine and Surgery, Karolinska Institutet, 171 76, Stockholm, Sweden.