Premium
Predictors of surgical quality for retroperitoneal sarcoma: Volume matters
Author(s) -
Maurice Matthew J.,
Yih Jessica M.,
Ammori John B.,
Abouassaly Robert
Publication year - 2017
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.24710
Subject(s) - medicine , odds ratio , univariate analysis , odds , surgery , resection , percentile , multivariate analysis , logistic regression , statistics , mathematics
Background and Objectives The volume‐outcome relationship is well recognized. We sought to investigate this relationship in retroperitoneal sarcoma (RPS) surgery. Methods Non‐metastatic RPS cases from 2004 to 2014 in the National Cancer Database were analyzed. Hospitals in the top 10th percentile for volume were defined as high‐volume. Outcomes were selected a priori based on their known prognostic significance, including surgery use, R0/R1 resection, and R0 resection. Volume‐outcome associations were assessed by univariate and multivariable analyses. Results Of 3141 RPS cases identified, 70.0% were managed surgically. Of these, 93.0% were R0/R1 resections, and 67.6% were R0 resections. Surgical management, R0/R1 resection, and R0 resection were each associated with improved overall survival ( P < 0.001). Hospital volume was an independent predictor of surgical management, R0 resection, and R0/R1 resection. Patients treated at high‐volume centers had 1.9‐fold higher odds of undergoing surgical management ( P < 0.001), 2.5‐fold higher odds of receiving a R0/R1 resection ( P = 0.026), and 1.8‐fold higher odds of an R0 resection ( P < 0.001). Academic setting predicted use of surgical management ( P < 0.001) and R0/R1 resection ( P = 0.015) but not R0 resection ( P = 0.882). Conclusions High‐volume hospitals are significantly associated with surgery use and improved surgical outcomes. Consideration should be given to further centralization of RPS care.