Nationwide study of hospital volume and mortality of gastric cancer in Finland.

No overall association between hospital volume and short- or long-term mortality.

Centralization of gastric cancer to high-volume hospitals may not decrease mortality.

Previous studies on hospital volume of gastrectomy and mortality in gastric cancer are conflicting, with some suggesting improved short-term outcomes in higher volume hospitals and fewer studies demonstrating consistent findings on long-term mortality benefits. This study evaluated the association between hospital volume and gastric cancer mortality in Finland during 1987-2016.

This population-based, nationwide, retrospective cohort study utilized patient data from the three national registries. Annual hospital volumes were divided into quartiles. The outcomes of interest were 30-day, 90-day and 5-year mortality. Multivariable Cox-regression hazard models provided HRs and 95% CI, adjusted for age, sex, calendar period, comorbidity, cancer stage, and neoadjuvant therapy, with missing data addressed through multiple imputation.

A total of 10,331 gastrectomy were identified. Highest volume quartile hospitals showed a gradual decrease in gastrectomy procedures compared to low-volume hospitals in later calendar periods. While no significant association was found between hospital volume quartile and short-term or long-term mortality in the overall analysis, the subgroup analysis for the years 2005-2016 revealed an increased risk of 90-day mortality in lowest volume quartile hospitals.

No significant association between hospital volume of gastrectomy and short- or long-term mortality was demonstrated. Centralization of gastric cancer patients to higher-volume hospitals might not decrease short- or long-term mortality.

Gastrectomy

High-volume hospitals

Low-volume hospitals

Mortality

Stomach neoplasms

© 2026 The Authors. Published by Elsevier Ltd.