Combined High-Volume Common Complex Cancer Operations Safeguard Long-Term Survival in a Low-Volume Individual Cancer Operation Setting

Background We previously demonstrated the importance of combined complex surgery volume on short-term outcomes of high-risk cancer operations. This study investigates the impact of combined common complex cancer operation volume on long-term outcomes at hospitals with low cancer-specific operation v...

Full description

Saved in:
Bibliographic Details
Published in:Annals of surgical oncology 2023-09, Vol.30 (9), p.5352-5360
Main Authors: Romatoski, Kelsey S., Chung, Sophie H., de Geus, Susanna W. L., Papageorge, Marianna V., Woods, Alison P., Rasic, Gordana, Ng, Sing Chau, Tseng, Jennifer F., Sachs, Teviah E.
Format: Article
Language:English
Subjects:
Cancer
Gastrectomy
Global Health Services Research
Hepatectomy
Hepatocellular carcinoma
Hospitals
Lung carcinoma
Medicine
Medicine & Public Health
Non-small cell lung carcinoma
Oncology
Patients
Small cell lung carcinoma
Surgery
Surgical Oncology
Citations: Items that this one cites
Items that cite this one
Online Access:Get full text
Tags: Add Tag
No Tags, Be the first to tag this record!
Description
Summary:Background We previously demonstrated the importance of combined complex surgery volume on short-term outcomes of high-risk cancer operations. This study investigates the impact of combined common complex cancer operation volume on long-term outcomes at hospitals with low cancer-specific operation volumes. Patients and Methods A retrospective cohort of National Cancer Data Base (2004–2019) patients undergoing surgery for hepatocellular carcinoma, non-small cell lung cancers, or pancreatic, gastric, esophageal, or rectal adenocarcinomas was utilized. Three separate cohorts were established: low-volume hospitals (LVH), mixed-volume hospitals (MVH) with low-volume individual cancer operations and high-volume total complex operations, and high-volume hospitals (HVH). Survival analyses were performed for overall, early-, and late-stage disease. Results The 5 year survival was significantly better at MVH and HVH compared with LVH, for all operations except late-stage hepatectomy (HVH survival > LVH and MVH). The 5 year survival probability was similar between MVH and HVH for operations on late-stage cancers. Early and overall survival for gastrectomy, esophagectomy, and proctectomy were equivalent between MVH and HVH. While early and overall survival for pancreatectomy were benefited by HVH over MVH, the opposite was true for lobectomy/pneumonectomy, which were benefited by MVH over HVH; however, none of these differences were likely to have an effect clinically. Only hepatectomy patients demonstrated statistical and clinical significance in 5 year survival at HVH compared with MVH for overall survival. Conclusions MVH hospitals performing sufficient complex common cancer operations demonstrate similar long-term survival for specific high-risk cancer operations to HVH. MVH provide an adjunctive model to the centralization of complex cancer surgery, while maintaining quality and access.
ISSN:1068-9265
1534-4681
DOI:10.1245/s10434-023-13680-4