Volume and process of care in high‐risk cancer surgery

Abstract

The adult subventricular zone (SVZ) contains progenitors cells, which continually give rise to new neurons that migrate along the rostral migratory stream (RMS) to the olfactory bulbs (OB). Prokineticin receptor 2 (ProKR2) is a G‐protein‐coupled receptor that plays an essential role in this migration process. However, the identity of the prokr2‐expressing cells has not yet been clearly established. Here, we have characterized in detail the identity of the prokr2‐expressing cells in the SVZ/RMS/OB pathway in adult mice. In the SVZ, accumulation of prokr2 transcripts was detected in almost all migrating neuroblasts or type A cells as well as in a large population of their precursors, the rapidly dividing type C cells. Moreover, we observed that, in dissociated SVZ cells from Mash1::GFP postnatal mice, ProKR2 protein is also present in type C and type A cells. We found that, along the RMS and in the OB, prokr2 expression was restricted to migrating type A cells and was absent in astrocytes. Finally, we observed a highly marked decrease of prokr2 expression in Mash1−/− mutant mice, suggesting that this transcription factor directly or indirectly regulates prokr2 expression. Although the expression of ProKR2 in migrating type A cells is in good agreement with the essential role played by this receptor during this migration process, its expression in a large population of their progenitors suggests an additional function for ProKR2, providing novel insights into the role of ProKR2/ProK2 signalling in adult neurogenesis. J. Comp. Neurol. 512:232–242, 2009. © 2008 Wiley‐Liss, Inc.

Are treatment outcomes in gastric cancer associated with either hospital volume or surgeon volume?

“…reported that the non‐elective admission rate was higher in very‐low‐volume hospitals than in very‐high‐volume hospitals (51.4% vs 29.7%), and that this discrepancy was possibly associated with a difference in mortality rates (13.0% vs 8.7%). A significant correlation between hospital volume and postoperative mortality was also observed in six studies in the USA 16, 17, 18, 19, 20, 21 and three studies in Europe 22, 23, 24. Among eight other large‐scale studies, only one could not show a significant relationship between higher hospital volume and lower hospital mortality, but the absolute difference in mortality between low‐ and high‐volume hospitals was greater than 1% (8.7% vs 6.9%) 25…”

Use of adjuvant radiotherapy at hospitals with and without on‐site radiation services

“…This hypothesis is plausible to the extent that hospitals with radiation facilities tend to be larger and have higher procedure volumes, factors that previously were linked to lower complication rates with pancreatic resection. 13,14 In the current study, we did observe that hospitals with on-site radiation services also had significantly higher procedure volumes for each cancer type. However, differences in the use of adjuvant therapy persisted after adjusting for procedure volume and seemed too large to be attributed solely to differences in postoperative complication rates.…”

Variations in gastric cancer care

“…Our observations and those of others also suggest that academic and comprehensive cancer centers are associated with higher case volumes. [22][23][24][25][26][27][28][29][30] Whether this particular association between nonwhite race and better surgical care exists in other malignancies deserves further investigation.…”