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Defining Volume Targets for Regionalization of Pancreaticoduodenectomy, Esophagectomy, and Major Lung Resection Centers to Improve Oncologic and Surgical Outcomes

  • Pancreatic Tumors
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Abstract

Background

Performance of complex cancer surgeries at high-volume (HV) centers has been shown to reduce operative mortality. However, the case volume threshold that should be used to define HV centers is unknown. In this study, we determined thresholds to define HV pancreaticoduodenectomy, esophagectomy, and major lung resection centers based on clinical parameters. Then, we assessed the association of hospital volume with oncologic outcomes and overall survival.

Methods

We identified adult NCDB patients undergoing pancreaticoduodenectomy, esophagectomy, and major lung resections between 2004 and 2015. Multivariable models with restricted cubic splines were built to predict 5-year overall survival for each surgery group according to average yearly case volume, adjusting for demographic and clinicopathologic factors. The change point procedure was then used to identify volume cut-points for each surgery type.

Results

We identified the following thresholds to define HV status: 25 cases/year for pancreaticoduodenectomy; 18 cases/year for esophagectomy; and 54 cases/year for major lung resections. For all surgery types, treatment at a HV center was associated with an increased likelihood of R0 resection and adequate lymph node evaluation. HV centers had significantly decreased 30- and 90-day, postoperative mortality after adjusting for age, sex, race, comorbidities, histology, and stage. An overall survival benefit also was observed for patients undergoing resections at HV centers.

Conclusions

Using novel methodology, our study identified volume thresholds for HV pancreaticoduodenectomy, esophagectomy, and major lung resection centers that were associated with improved oncologic outcomes and overall survival. These definitions of HV centers should be considered when evaluating regionalization of complex cancer care.

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Data availability

The datasets generated during and/or analyzed during the current study are not publicly available but are available from the corresponding author on reasonable request.

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Funding

JDK was supported by a Physician-Scientist Institutional Award from the Burroughs Wellcome Fund (award No. 1018897).

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Authors and Affiliations

  1. Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA

    Michelle R. Ju MD, John D. Karalis MD, Grey Leonard MD, John C. Mansour MD, Georgios Karagkounis MD, Sam C. Wang MD & Matthew R. Porembka MD

  2. Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, USA

    Scott I. Reznik MD

Authors
  1. Michelle R. Ju MD
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  2. John D. Karalis MD
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  3. Grey Leonard MD
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  4. John C. Mansour MD
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  5. Georgios Karagkounis MD
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Correspondence to Matthew R. Porembka MD.

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Ju, M.R., Karalis, J.D., Leonard, G. et al. Defining Volume Targets for Regionalization of Pancreaticoduodenectomy, Esophagectomy, and Major Lung Resection Centers to Improve Oncologic and Surgical Outcomes. Ann Surg Oncol 31, 499–513 (2024). https://doi.org/10.1245/s10434-023-14339-w

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