Predictors of surgical quality for retroperitoneal sarcoma: Volume matters

Abstract

High-volume hospitals are significantly associated with surgery use and improved surgical outcomes. Consideration should be given to further centralization of RPS care.

Is surgery for retroperitoneal sarcoma at “low‐volume” hospitals a bad idea?

“…Moreover, this hypothesis is consistent with findings for other cancers showing lower operative mortality rates when surgeries are performed in hospitals with specialty expertise . Two recent studies using large cohorts from the National Cancer Data Base, one by Maurice et al and another by Keung et al published in this issue of Cancer , conclude that there is evidence to support a volume‐outcome association for patients with retroperitoneal sarcoma. Maurice et al go further and suggest regionalization of retroperitoneal sarcoma care to high‐volume centers.…”

“…Two recent studies using large cohorts from the National Cancer Data Base, one by Maurice et al and another by Keung et al published in this issue of Cancer , conclude that there is evidence to support a volume‐outcome association for patients with retroperitoneal sarcoma. Maurice et al go further and suggest regionalization of retroperitoneal sarcoma care to high‐volume centers. These authors have obtained unique databases to address this important hypothesis.…”

“…This allows a quantitative comparison of the estimate of the association. With the retroperitoneal studies, even in a valid analysis with appropriate adjustments for clustering, a direct quantitative comparison would not be possible because the groups used different definitions of high‐volume hospitals (an average of 5 or more cases per year per hospital for Maurice et al with 70% of all cases undergoing surgical management and more than 10 surgeries per year with a secondary analysis of 0‐5, 6‐10, and more than 10 surgeries per year for Keung et al). Categorization can also yield questionable findings as a result of influential outliers .…”

Treatment at low‐volume hospitals is associated with reduced short‐term and long‐term outcomes for patients with retroperitoneal sarcoma

“…Also using the NCDB, Maurice et al reported outcomes among 3141 patients with RPS. However, approximately 30% of patients in this study did not undergo surgical resection and an HVH was defined as a hospital performing at least 5 surgical resections per year . Although RPS treatment at HVHs in this study was associated with higher rates of surgical resection and R0/R1 surgical resection, the authors did not find a survival difference between patients treated at HVHs and those treated at LVHs …”

“…To our knowledge, the current study is the first to investigate the impact of hospital volume on outcomes among patients undergoing surgical resection for RPS. Although 2 prior studies examined hospital volume and outcomes in patients with sarcoma, these studies were limited for several reasons . Gutierrez et al reported outcomes among 4205 patients with STS who were undergoing surgical resection, and demonstrated lower 30‐day and 90‐day mortality in patients treated at HVHs .…”