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.
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