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

  • Global Health Services Research
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

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.

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Acknowledgement

The authors have no conflicts of interest to disclose. Kelsey Romatoski and Sophie Chung are supported by the Health Resources Services Administration’s National Research Service Award grant number T32HP10028. The content is solely the responsibility of the authors and does not necessarily represent official views of the supporting institutions. Each author meets authorship criteria per the guidelines of the International Committee of Medical Journal Editors (ICMJE) and has participated sufficiently to the manuscript to take public responsibility for appropriate proportions of the content.

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Authors and Affiliations

  1. Department of Surgery, Boston Medical Center, Chobanian & Avedisian School of Medicine, Boston University, Boston, MA, USA

    Kelsey S. Romatoski MD, Sophie H. Chung MD, Susanna W. L. de Geus MD, PhD, Gordana Rasic MD, MS, Sing Chau Ng MS, Jennifer F. Tseng MD, MPH & Teviah E. Sachs MD, MPH

  2. Department of Surgery, Beth Israel Deaconess Medical Center, Harvard Medical School, Boston, MA, USA

    Kelsey S. Romatoski MD & Susanna W. L. de Geus MD, PhD

  3. Department of Surgery, Yale New Haven Hospital, Yale School of Medicine, New Haven, CT, USA

    Marianna V. Papageorge MD, MPH

  4. Division of Surgical Oncology, Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA

    Alison P. Woods MD, MPH

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  1. Kelsey S. Romatoski MD
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Correspondence to Teviah E. Sachs MD, MPH.

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Meeting presentation: New England Surgical Society presentation in 2022.

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Romatoski, K.S., Chung, S.H., de Geus, S.W.L. et al. Combined High-Volume Common Complex Cancer Operations Safeguard Long-Term Survival in a Low-Volume Individual Cancer Operation Setting. Ann Surg Oncol 30, 5352–5360 (2023). https://doi.org/10.1245/s10434-023-13680-4

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