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Outcomes in Oncologic Surgery: Does Volume Make a Difference?

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Abstract

Commonly performed elective surgical procedures on the alimentary tract are carried out with low morbidity and low mortality in most hospitals in the United States. There are some procedures on the alimentary tract that are performed with a relatively low frequency and are associated with higher mortality. Volume is a surrogate marker associated with improved outcome, with relative differences being dependent on the complexity of the procedure and the frequency with which it is done. Both surgeon and institutional volume matters, but it seems that improved operative mortality can be reached with lower surgeon volume in high-volume institutions. It appears that volume can be substituted in part for by specialization and training, with improved outcomes based on specialist credentials and fellowship training.

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References

  1. Luft HS, Bunker JP, Enthoven AC. Should operations be regionalized? The empirical relation between surgical volume and mortality. N. Engl. J. Med. 1979; 301:1364–1369

    Article  PubMed  CAS  Google Scholar 

  2. Birkmeyer JD, Stukel TA, Siewers AE, et al. Surgeon volume and operative mortality in the United States. N. Engl. J. Med. 2003;349:2117–2127

    Article  PubMed  CAS  Google Scholar 

  3. Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N. Engl. J. Med. 2002; 346:1128–1137

    Article  PubMed  Google Scholar 

  4. Sainsbury R, Haward B, Rider L, et al. Influence of clinician workload and patterns of treatment on survival from breast cancer. Lancet 1995;345:1265–1270

    Article  PubMed  CAS  Google Scholar 

  5. Schrag D, Panageas KS, Riedel E, et al. Hospital and surgeon procedure volume as predictors of outcome following rectal cancer resection. Ann. Surg. 2002;236:583–592

    Article  PubMed  Google Scholar 

  6. Ritchie WP Jr., Rhodes RS, Biester TW. Work loads and practice patterns of general surgeons in the United States, 1995–1997: a report from the American Board of Surgery. Ann. Surg. 1999;230:533–542

    Article  PubMed  Google Scholar 

  7. Gordon TA, Bowman HM, Bass EB, et al. Complex gastrointestinal surgery: impact of provider experience on clinical and economic outcomes. J. Am. Coll. Surg. 1999;189:46–56

    Article  PubMed  CAS  Google Scholar 

  8. Porter GA, Pisters PW, Mansyur C, et al. Cost and utilization impact of a clinical pathway for patients undergoing pancreaticoduodenectomy. Ann. Surg. Oncol. 2000;7:484–489

    PubMed  CAS  Google Scholar 

  9. Hannan EL, Radzyner M, Rubin D, et al. The influence of hospital and surgeon volume on in-hospital mortality for colectomy, gastrectomy, and lung lobectomy in patients with cancer. Surgery 2002;131:6–15

    Article  PubMed  Google Scholar 

  10. Schrag D, Panageas KS, Riedel E, et al. Surgeon volume compared to hospital volume as a predictor of outcome following primary colon cancer resection. J. Surg. Oncol. 2003;83:68–78

    Article  PubMed  Google Scholar 

  11. Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch. Surg. 2003;138:721–725

    PubMed  Google Scholar 

  12. Harmon JW, Tang DG, Gordon TA, et al. Hospital volume can serve as a surrogate for surgeon volume for achieving excellent outcomes in colorectal resection. Ann. Surg. 1999;230:404–411

    Article  PubMed  CAS  Google Scholar 

  13. Prystowsky JB, Bordage G, Feinglass JM. Patient outcomes for segmental colon resection according to surgeon’s training, certification, and experience. Surgery 2002;2132:663–670

    Google Scholar 

  14. Khuri SF, Daley J, Henderson W, et al. Relation of surgical volume to outcome in eight common operations: results from the VA National Surgical Quality Improvement Program. Ann. Surg. 1999;230:414–429

    Article  PubMed  CAS  Google Scholar 

  15. Begg CB, Cramer LD, Hoskins WJ, et al. Impact of hospital volume on operative mortality for major cancer surgery. J.A.M.A 1998;280:1747–1751

    Article  PubMed  CAS  Google Scholar 

  16. Choti MA, Bowman HM, Pitt HA, et al. Should hepatic resections be performed at high-volume referral centers? J. Gastrointest. Surg. 1998;2:11–20

    Article  PubMed  CAS  Google Scholar 

  17. Glasgow RE, Showstack JA, Katz PP, et al. The relationship between hospital volume and outcomes of hepatic resection for hepatocellular carcinoma. Arch. Surg. 1999;134:30–35

    PubMed  CAS  Google Scholar 

  18. Dimick JB, Cowan JA Jr., Knol JA, et al. Hepatic resection in the United States: indications, outcomes, and hospital procedural volumes from a nationally representative database. Arch. Surg. 2003;138:185–191

    PubMed  Google Scholar 

  19. Yeo CJ, Cameron JL, Sohn TA, et al. Six hundred fifty consecutive pancreaticoduodenectomies in the 1990s: pathology, complications, and outcomes. Ann. Surg. 1991;226:248–257

    Google Scholar 

  20. Pellegrini CA, Heck CF, Raper S, et al. An analysis of the reduced morbidity and mortality rates after pancreaticoduodenectomy. Arch. Surg. 1989;124:778–781

    PubMed  CAS  Google Scholar 

  21. Stojadinovic A, Brooks A, Hoos A, et al. An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J. Am. Coll. Surg. 2003;196:954–964

    Article  PubMed  Google Scholar 

  22. Sosa JA, Bowman HM, Gordon TA, et al. Importance of hospital volume in the overall management of pancreatic cancer. Ann. Surg. 1998;228:429–438

    PubMed  CAS  Google Scholar 

  23. Balcom JHT, Rattner DW, Warshaw AL, et al. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch. Surg. 2001;136:391–398

    PubMed  Google Scholar 

  24. Ho V, Heslin MJ. Effect of hospital volume and experience on in-hospital mortality for pancreaticoduodenectomy. Ann. Surg. 2003;237:509–514

    Article  PubMed  Google Scholar 

  25. Lieberman MD, Kilburn H, Lindsey M, et al. Relation of perioperative deaths to hospital volume among patients undergoing pancreatic resection for malignancy. Ann. Surg. 1995;222:638–645

    PubMed  CAS  Google Scholar 

  26. Gordon TA, Burleyson GP, Tielsch JM, et al. The effects of regionalization on cost and outcome for one general high-risk surgical procedure. Ann. Surg. 1995;221:43–49

    PubMed  CAS  Google Scholar 

  27. Gordon TA, Bowman HM, Tielsch JM, et al. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann. Surg. 1998;228:71–78

    Article  PubMed  CAS  Google Scholar 

  28. Goodney PP, Stukel TA, Lucas FL, et al. Hospital volume, length of stay, and readmission rates in high-risk surgery. Ann. Surg. 2003;238:161–167

    Article  PubMed  Google Scholar 

  29. Finlayson EV, Birkmeyer JD. Effects of hospital volume on life expectancy after selected cancer operations in older adults: a decision analysis. J. Am. Coll. Surg. 2003;196:410–417

    Article  PubMed  Google Scholar 

  30. Edge SB, Schmieg RE Jr., Rosenlof LK, et al. Pancreas cancer resection outcome in American university centers in 1989–1990. Cancer 1993;71:3502–3508

    PubMed  CAS  Google Scholar 

  31. Janes RH Jr., Niederhuber JE, Chmiel JS, et al. National patterns of care for pancreatic cancer. Results of a survey by the Commission on Cancer. Ann. Surg. 1996;223:261–272

    Article  PubMed  Google Scholar 

  32. Andren-Sandberg A, Ihse I. Factors influencing survival after total pancreatectomy in patients with pancreatic cancer. Ann. Surg. 1983;198:605–610

    PubMed  CAS  Google Scholar 

  33. Rizk NP, Bach PB, Schrag D, et al. The impact of complications on outcomes after resection for esophageal and gastroesophageal junction carcinoma. J. Am. Coll. Surg. 2004;198:42–50

    Article  PubMed  Google Scholar 

  34. Patti MG, Corvera CU, Glasgow RE, et al. A hospital’s annual rate of esophagectomy influences the operative mortality rate. J. Gastrointest. Surg. 1998;2:186–192

    PubMed  CAS  Google Scholar 

  35. Dimick JB, Pronovost PJ, Cowan JA, et al. Surgical volume and quality of care for esophageal resection: do high-volume hospitals have fewer complications? Ann. Thorac. Surg. 2003;75:337–341

    Article  PubMed  Google Scholar 

  36. Dimick JB, Cowan JA Jr., Ailawadi G, et al. National variation in operative mortality rates for esophageal resection and the need for quality improvement. Arch. Surg. 2003;138:1305–1309

    PubMed  Google Scholar 

  37. Hewitt M, Petitti D. Interpreting the Volume–Outcome Relationship in the Context of Cancer Care. Washington, DC National Academy Press, 2001

    Google Scholar 

  38. Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery 2001;130:415–422

    Article  PubMed  CAS  Google Scholar 

  39. Ihse I. The volume–outcome relationship in cancer surgery: a hard sell. Ann. Surg. 2003;238:777–781

    PubMed  Google Scholar 

  40. Finlayson SR, Birkmeyer JD, Tosteson AN, et al. RF, Patient preferences for location of care: implications for regionalization. Med. Care 1999;37:204–209

    Article  PubMed  CAS  Google Scholar 

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Authors and Affiliations

  1. Department of Surgery, Memorial Sloan-Kettering Cancer Center, 1275 York Avenue, New York, NY, 10021, USA

    David J. Bentrem M.D. & Murray F. Brennan M.D.

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  1. David J. Bentrem M.D.
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  2. Murray F. Brennan M.D.
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Correspondence to Murray F. Brennan M.D..

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Bentrem, D.J., Brennan, M.F. Outcomes in Oncologic Surgery: Does Volume Make a Difference?. World J. Surg. 29, 1210–1216 (2005). https://doi.org/10.1007/s00268-005-7991-x

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  • DOI: https://doi.org/10.1007/s00268-005-7991-x

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