title: Can smaller-scale comprehensive cancer centers provide outstanding care in abdominal and thoracic pediatric solid tumor surgery? Results of a 14-year retrospective single-center analysis.
abstract: OBJECTIVE
  Quality of care and its measurement represent a considerable challenge for pediatric smaller-scale comprehensive cancer centers (pSSCC) providing surgical oncology services. It remains unclear whether center size and/or yearly case-flow numbers influence the quality of care, and therefore impact outcomes for this population of patients.
  
  
  METHODS
  We performed a 14-year, retrospective, single-center analysis, assessing adherence to treatment protocols and surgical adverse events as quality indicators in abdominal and thoracic pediatric solid tumor surgery.
  
  
  RESULTS
  Forty-eight patients, enrolled in a research-associated treatment protocol, underwent 51 cancer-oriented surgical procedures. All the protocols contain precise technical criteria, indications, and instructions for tumor surgery. Overall, compliance with such items was very high, with 997/1,035 items (95 %) meeting protocol requirements. There was no surgical mortality. Twenty-one patients (43 %) had one or more complications, for a total of 34 complications (66 % of procedures). Overall, 85 % of complications were grade 1 or 2 according to Clavien-Dindo classification requiring observation or minor medical treatment. Case-sample and outcome/effectiveness data were comparable to published series. Overall, our data suggest that even with the modest caseload of a pSSCC within a Swiss tertiary academic hospital, compliance with international standards can be very high, and the incidence of adverse events can be kept minimal.
  
  
  CONCLUSIONS
  Open and objective data sharing, and discussion between pSSCCs, will ultimately benefit our patient populations. Our study is an initial step towards the enhancement of critical self-review and quality-of-care measurements in this setting.
authors.affiliation: Division of Pediatric Surgery, Department of Pediatrics and Pediatric Surgery (DMCP), University Hospital of Lausanne, Lausanne, Switzerland, jean-marc.joseph@chuv.ch.
authors.forename: J M
authors.initials: JM
authors.lastname: Joseph
authors.forename: A M
authors.initials: AM
authors.lastname: Farron
authors.forename: R
authors.initials: R
authors.lastname: Renella
authors.forename: C
authors.initials: C
authors.lastname: Gapany
mesh_terms: D000008:Abdominal Neoplasms / Q000401:mortality / Q000601:surgery*; D000293:Adolescent; D002173:Cancer Care Facilities / Q000706:statistics & numerical data*; D002648:Child; D002675:Child, Preschool; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007223:Infant; D008297:Male; D009367:Neoplasm Staging; D009369:Neoplasms / Q000401:mortality / Q000601:surgery*; D010372:Pediatrics; D011183:Postoperative Complications; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D019616:Thoracic Surgical Procedures