Impact of volume and specialization for cancer surgery.
OBJECTIVE
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.


CONCLUSIONS
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.
Department of Surgery, University of Heidelberg, DE-69120 Heidelberg, Germany.
Jürgen
J
Weitz
Moritz
M
Koch
Helmut
H
Friess
Markus W
MW
Büchler
D002983:Clinical Competence; D006801:Humans; D008511:Medicine / Q000592:standards*; D009369:Neoplasms / Q000601:surgery*; D010043:Outcome and Process Assessment, Health Care; D011787:Quality of Health Care; D013038:Specialization; D013503:Surgery Department, Hospital / Q000706:statistics & numerical data