Impact of Volume and Specialization for Cancer SurgeryWeitz J. · Koch M. · Friess H. · Büchler M.W.
Department of Surgery, University of Heidelberg, Heidelberg, Germany
Background/Aims: The so-called volume/outcome relationship postulates that a higher caseload and specialization results in an improved outcome. The existence of such a relationship, however, is still debated in the literature. The objective of this review is to discuss the available data on this relationship in surgical oncology. Methods: A Medline analysis was performed using the following terms: volume, outcome, cancer, and surgery. The bibliography of each relevant article was screened for further studies. Results: For most malignancies a volume/outcome relationship was demonstrated in recent years. Components of this improved outcome are decreased perioperative morbidity and mortality, higher quality of life after surgery, improved economic outcome, and a better long-term prognosis for patients with cancer. The magnitude of this relationship, however, varies greatly among different malignancies. The exact reason for the volume/outcome relationship is still unknown. Conclusion: Concentrating high-risk procedures in high-volume hospitals might prevent thousands of perioperative deaths per year. This concept seems feasible for rare and high-risk diseases; however, it is unclear what threshold should be used for the definition of a high-volume provider. For common and low-risk diagnoses, it seems more realistic to educate the medical community in order to improve the outcome for the patients.
© 2004 S. Karger AG, Basel
M.W. Büchler, MD
Department of Surgery, University of Heidelberg, INF 110
DE–69120 Heidelberg (Germany)
Tel. +49 6221 566200, Fax +49 6221 565450
Published online: August 11, 2004
Number of Print Pages : 9
Number of Figures : 0, Number of Tables : 5, Number of References : 88
Official Publication of the International Society for Digestive Surgery (ISDS, formerly CICD), European Digestive Surgery (EDS), Dutch Society of Gastro-Intestinal Surgery (NVGIC), Japanese Society of Gastroenterological Surgery (JSGS), Hellenic Society for Digestive Surgery (HSDS)
Vol. 21, No. 4, Year 2004 (Cover Date: 2004)
Journal Editor: M.W. Büchler, Heidelberg; J.P. Neoptolemos, Liverpool
ISSN: 0253–4886 (print), 1421–9983 (Online)
For additional information: http://www.karger.com/dsu