Key result
Higher surgical volume and specialization in cancer surgery are associated with decreased perioperative morbidity and mortality, higher quality of life, and better long-term prognosis.
Why the study?
Does a higher caseload and specialization improve outcomes in patients undergoing cancer surgery?
Does a higher caseload and specialization improve outcomes in patients undergoing cancer surgery?
Concentrating high-risk cancer surgeries in high-volume hospitals may improve patient outcomes and prevent perioperative deaths.
High-volume referral may improve cancer surgery outcomes; leaves open need for randomized confirmation.
BACKGROUND/AIMS: The so-called volume/outcome relationship postulates that a higher caseload and specialization results in an improved outcome. The existence of such a relationship, however, is still debated in the literature. The objective of this review is to discuss the available data on this relationship in surgical oncology. METHODS: A Medline analysis was performed using the following terms: volume, outcome, cancer, and surgery. The bibliography of each relevant article was screened for further studies. RESULTS: For most malignancies a volume/outcome relationship was demonstrated in recent years. Components of this improved outcome are decreased perioperative morbidity and mortality, higher quality of life after surgery, improved economic outcome, and a better long-term prognosis for patients with cancer. The magnitude of this relationship, however, varies greatly among different malignancies. The exact reason for the volume/outcome relationship is still unknown. CONCLUSION: Concentrating high-risk procedures in high-volume hospitals might prevent thousands of perioperative deaths per year. This concept seems feasible for rare and high-risk diseases; however, it is unclear what threshold should be used for the definition of a high-volume provider. For common and low-risk diagnoses, it seems more realistic to educate the medical community in order to improve the outcome for the patients.
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Weitz et al. (2004) conducted a review in Cancer. High surgical volume and specialization vs. Low surgical volume was evaluated on Perioperative morbidity and mortality, quality of life, economic outcome, and long-term prognosis. Higher surgical volume and specialization in cancer surgery are associated with decreased perioperative morbidity and mortality, higher quality of life, and better long-term prognosis.
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