دورية أكاديمية
Defining Volume Targets for Regionalization of Pancreaticoduodenectomy, Esophagectomy, and Major Lung Resection Centers to Improve Oncologic and Surgical Outcomes.
| العنوان: | Defining Volume Targets for Regionalization of Pancreaticoduodenectomy, Esophagectomy, and Major Lung Resection Centers to Improve Oncologic and Surgical Outcomes. |
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| المؤلفون: | Ju MR; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Karalis JD; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Leonard G; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Mansour JC; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Karagkounis G; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Wang SC; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA., Reznik SI; Division of Thoracic Surgery, Department of Cardiovascular and Thoracic Surgery, University of Texas Southwestern Medical Center, Dallas, USA., Porembka MR; Division of Surgical Oncology, Department of Surgery, University of Texas Southwestern Medical Center, Dallas, TX, USA. matthew.porembka@utsouthwestern.edu. |
| المصدر: | Annals of surgical oncology [Ann Surg Oncol] 2024 Jan; Vol. 31 (1), pp. 499-513. Date of Electronic Publication: 2023 Sep 27. |
| نوع المنشور: | Journal Article |
| اللغة: | English |
| بيانات الدورية: | Publisher: Springer Country of Publication: United States NLM ID: 9420840 Publication Model: Print-Electronic Cited Medium: Internet ISSN: 1534-4681 (Electronic) Linking ISSN: 10689265 NLM ISO Abbreviation: Ann Surg Oncol Subsets: MEDLINE |
| أسماء مطبوعة: | Publication: 2005- : New York, NY : Springer Original Publication: New York, NY : Raven Press, c1994- |
| مواضيع طبية MeSH: | Pancreaticoduodenectomy* , Esophagectomy*, Adult ; Humans ; Retrospective Studies ; Treatment Outcome ; Lung ; Hospital Mortality ; Hospitals, High-Volume |
| مستخلص: | Background: Performance of complex cancer surgeries at high-volume (HV) centers has been shown to reduce operative mortality. However, the case volume threshold that should be used to define HV centers is unknown. In this study, we determined thresholds to define HV pancreaticoduodenectomy, esophagectomy, and major lung resection centers based on clinical parameters. Then, we assessed the association of hospital volume with oncologic outcomes and overall survival. Methods: We identified adult NCDB patients undergoing pancreaticoduodenectomy, esophagectomy, and major lung resections between 2004 and 2015. Multivariable models with restricted cubic splines were built to predict 5-year overall survival for each surgery group according to average yearly case volume, adjusting for demographic and clinicopathologic factors. The change point procedure was then used to identify volume cut-points for each surgery type. Results: We identified the following thresholds to define HV status: 25 cases/year for pancreaticoduodenectomy; 18 cases/year for esophagectomy; and 54 cases/year for major lung resections. For all surgery types, treatment at a HV center was associated with an increased likelihood of R0 resection and adequate lymph node evaluation. HV centers had significantly decreased 30- and 90-day, postoperative mortality after adjusting for age, sex, race, comorbidities, histology, and stage. An overall survival benefit also was observed for patients undergoing resections at HV centers. Conclusions: Using novel methodology, our study identified volume thresholds for HV pancreaticoduodenectomy, esophagectomy, and major lung resection centers that were associated with improved oncologic outcomes and overall survival. These definitions of HV centers should be considered when evaluating regionalization of complex cancer care. (© 2023. Society of Surgical Oncology.) |
| التعليقات: | Comment in: Ann Surg Oncol. 2023 Dec;30(13):8596-8597. (PMID: 37775687) |
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| معلومات مُعتمدة: | 1018897 Burroughs Wellcome Fund |
| تواريخ الأحداث: | Date Created: 20230927 Date Completed: 20231207 Latest Revision: 20240423 |
| رمز التحديث: | 20240423 |
| DOI: | 10.1245/s10434-023-14339-w |
| PMID: | 37755565 |
| قاعدة البيانات: | MEDLINE |
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Full Text Finder | تدمد: | 1534-4681 |
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| DOI: | 10.1245/s10434-023-14339-w |