Centralized Care of the Surgical Oncology Patient: A Simple Task with Complex Solutions

Excerpt

Over the past decades, considerable research has focused on the correlation between surgical procedural volume and patient-centered outcomes.^1,2 Successful oncologic resections of the pancreas, esophagus and lung, for example, typically require specialized surgical expertise intertwined with multidisciplinary cancer care commonly available at high-volume (HV) centers of excellence.^1,2 In their paper, Ju et al.³ rekindle the debate around optimal surgical volumes for three major oncologic resections—pancreaticoduodenectomy (PD), esophagectomy, and lobectomy/pneumonectomy. By applying sophisticated statistical methodology to a National Cancer Database (NCDB) cohort of patients between 2004 and 2015, the authors identify volume thresholds at which outcomes become superior for patients treated at HV versus low-volume (LV) facilities. Based on their analysis, they propose cut-offs for an HV hospital of 25 cases for PD, 18 cases for esophagectomy, and 54 cases for lobectomy/pneumonectomy. Using these criteria, patients at HV centers had decreased 30- and 90-day mortality, higher rates of R0 resection with adequate lymphadenectomy, and improved overall survival. At least for their study period ending in 2015, the proposed cut-offs would result in PDs, esophagectomies, and major lung resections being restricted to 8/1163, 16/1232, and 109/1322 HV facilities within the NCDB, respectively. …