High-Volume Centers – Effect of Case Load on Outcome in Cancer Surgery

Abstract

The detailed analysis of the literature of the past 10 years comprising 12 papers concerning pancreatic cancer and 10 dealing with esophageal cancer show a clear reduction of postoperative mortality with increasing case volume per year. Single papers have analyzed the main reasons for this phenomenon and showed that postoperative complication rates are lower in high-volume hospitals and their management of complications is more successful. Further long-term prognosis is also correlated to case volume. Surgery of pancreatic and esophageal cancer is a task for high-volume hospitals because they have less postoperative mortality and improved long-term prognosis compared to low-volume hospitals.

Impact of a Hospital?s Workload on Clinical Outcome after Resection for Carcinoma of the Esophagus

“…For centers treating more than 20 patients per year, this rate dropped more than half with a median of 4.9%. This literature analysis confirmed the described trend found in the individual studies with a clear correlation between case number and post-operative mortality [4,8,12,16,24,30] .…”

Preoperative risk analysis—a reliable predictor of postoperative outcome after transthoracic esophagectomy?

“…Due to the high morbidity and mortality rates after esophagectomy, it has been advocated to treat patients with esophageal cancer in high volume centers [10,11]. As demonstrated in this prospective analysis, highly specialized centers report mortality rates of approximately 5% depending on the number of esophagectomies performed [1,12].…”

Chirurgie des Barrett-Adenokarzinoms

“…Hingegen konnten mittels innovativer molekularbiologischer Techniken Marker beschrieben werden, die eine «Response»-Prädiktion neoadjuvanter Therapien beim Öso- [13]. Dies liegt vor allem an der geringeren postoperativen Komplikationsrate sowie dem besseren Komplikationsmanagement in den sogenannten «High-volume-Zentren».…”