Is surgery for retroperitoneal sarcoma at “low‐volume” hospitals a bad idea?

Putt, Mary

doi:10.1002/cncr.31750

Cited by 5 publications

(3 citation statements)

References 15 publications

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“…However, it is also possible that the lack of change reflects a lack of referrals to specialized centers. The etiology of the static rate of MVR warrants attention in future studies as this may be a target for increasing both MVR rates and referrals to specialized sarcoma centers with the goal of improving both postoperative morbidity and mortality as well as oncologic outcomes …”

Section: Discussionmentioning

confidence: 99%

Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS‐NSQIP follow up analysis

Judge

Lata-Arias

Yanagisawa

et al. 2019

Journal of Surgical Oncology

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Background: Calls for multivisceral resection (MVR) of retroperitoneal sarcoma (RPS) are increasing, although the risks and benefits remain controversial. We sought to analyze current 30-day morbidity and mortality rates, and trends in utilization of MVR in a national database.Methods: Overall morbidity, severe morbidity, mortality rates, and temporal trends were analyzed utilizing the American College of Surgeons National Surgical Quality Improvement Program (ACS-NSQIP).Results: From 2012 to 2015, a total of 564 patients underwent RPS resection with 233 patients (41%) undergoing MVR. The MVR group had a higher rate of preoperative weight loss and larger tumors overall. When comparing MVR to non-MVR, there was no significant difference in overall morbidity (22% vs 17%, P = .13), severe morbidity (11% vs 8%, P = .18), or mortality (<1% vs 2%, P = .25). On multivariate analysis, MVR was not associated with increased overall morbidity or severe morbidity. Mortality rates were too low for meaningful statistical analysis.Annual rates of MVR ranged from 37% to 46% with no significant change over time (P = .47).Results: Short-term morbidity and mortality rates after MVR for RPS remain acceptable, but rates of MVR show little change over time in NSQIP hospitals.Concerns about increased morbidity and mortality should not be viewed as a contraindication to wider implementation of MVR for RPS.

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Section: Discussionmentioning

confidence: 99%

Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS‐NSQIP follow up analysis

Judge

Lata-Arias

Yanagisawa

et al. 2019

Journal of Surgical Oncology

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“…Alternatively, highvolume centers may unintentionally select for patients more likely to have favorable outcomes, possibly in part due to socioeconomic factors. Prior authors have discussed that such retrospective studies must be interpreted with caution [10].…”

Section: Introductionmentioning

confidence: 99%

Socio-economic factors do not affect overall survival in soft tissue sarcoma when patients treated at a single high-volume center

et al. 2021

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Background Treatments for soft tissue sarcoma (STS) include extensive surgical resection, radiation and chemotherapy, and can necessitate specialized care and excellent social support. Studies have demonstrated that socioeconomic factors, such as income, marital status, urban/rural residence, and educational attainment as well as treatment at high-volume institution may be associated with overall survival (OS) in STS. Methods In order to explore the effect of socio-economic factors on OS in patients treated at a high-volume center, we performed a retrospective analysis of STS patients treated at a single institution. Results Overall, 435 patients were included. Thirty-seven percent had grade 3 tumors and 44% had disease larger than 5 cm. Patients were most commonly privately insured (38%), married (67%) and retired or unemployed (43%). Median distance from the treatment center was 42 miles and median area deprivation index (ADI) was 5 (10 representing most deprived communities). The majority of patients (52%) were treated with neoadjuvant therapy followed by resection. As expected, higher tumor grade (HR 3.1), tumor size > 5 cm (HR 1.3), and involved lymph nodes (HR 3.2) were significantly associated with OS on multivariate analysis. Demographic and socioeconomic factors, including sex, age at diagnosis, marital status, employment status, urban vs. rural location, income, education, distance to the treatment center, and ADI were not associated with OS. Conclusions In contrast to prior studies, we did not identify a significant association between socioeconomic factors and OS of patients with STS when patients were treated at a single high-volume center. Treatment at a high volume institution may mitigate the importance of socio-economic factors in the OS of STS.

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“…A separate editorial also accompanying the article by Keung et al addresses the validity of the statistical analysis as reported, and therefore we will not explore that herein. Although the difference in actual survival numbers may be debatable, the critical point that the overwhelming majority of patients who undergo treatment for a rare disease are treated at LVHs cannot be underemphasized.…”

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confidence: 99%

A call to action: Why sarcoma surgery needs to be centralized

Raut

Bonvalot

Gronchi

2018

Cancer

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Although experts agree that complex surgeries or those that are performed for patients with rare conditions should be performed at high‐volume centers, the majority of patients with primary retroperitoneal sarcoma undergo surgical resection at centers with relatively low volumes. This has implications for both immediate patient outcome and long‐term clinical trial success, and highlights the importance of centralizing care for patients with such rare cancers.

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Is surgery for retroperitoneal sarcoma at “low‐volume” hospitals a bad idea?

Cited by 5 publications

References 15 publications

Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS‐NSQIP follow up analysis

Morbidity, mortality and temporal trends in the surgical management of retroperitoneal sarcoma: An ACS‐NSQIP follow up analysis

Socio-economic factors do not affect overall survival in soft tissue sarcoma when patients treated at a single high-volume center

A call to action: Why sarcoma surgery needs to be centralized

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