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Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion.

by Villano, Anthony M; Zeymo, Alexander; Chan, Kitty; Shara, Nawar M; Al-Refaie, Waddah B.
Citation: Journal of the American College of Surgeons. 2019 Oct 11.Journal: Journal of the American College of Surgeons.Published: ; 2019ISSN: 1072-7515.Full author list: Villano AM; Zeymo A; Chan KS; Shara N; Al-Refaie WB.UI/PMID: 31672672.Subject(s): IN PROCESS -- NOT YET INDEXEDInstitution(s): MedStar Washington Hospital Center | MedStar Health Research InstituteDepartment(s): Surgery/General SurgeryActivity type: Journal Article.Medline article type(s): Journal ArticleDigital Object Identifier: (Click here) Abbreviated citation: J Am Coll Surg. 2019 Oct 11.Local Holdings: Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007.Abstract: BACKGROUND: The complexity of retroperitoneal soft tissue sarcoma (RPS) surgery has prompted international recommendations to regionalize it to high-volume hospitals (HVH's). A minimum procedural volume threshold for RPS is not yet defined, hampering effective referral and regionalization in the US. This multi-hospital study sought to establish a HVH threshold informed by national data and international expert opinion.Abstract: STUDY DESIGN: The 2004-2015 National Cancer Database identified 8,721 surgically treated RPS patients. Multivariable models, utilizing linear splines, identified annual volume thresholds predictive of overall and 90-day mortality. Transatlantic Australasian Retroperitoneal Soft Tissue Sarcoma Working Group members (n=48) completed a 15-item survey regarding this data.Abstract: RESULTS: Overall mortality risk was reduced by 4% per additional case (HR 0.96, 95% CI 0.95-0.98) up to a threshold of 13 cases/year; no further reduction was observed over 13 (HR 0.99, 95% CI 0.97-1.01). After revealing the results from our statistical analysis, 71.4% of respondents who initially chose >30 cases/year as a cutoff shifted their response to a lower value. Over 56% cited 11-20 procedures/year as the cutoff for a HVH. Median survival in hospitals with <13 vs. >13 cases/year was 94 vs. 139 months (p<0.001). 40% of respondents cited 1-2% as an acceptable 90-day mortality. This was achieved with a minimum of 13 cases/year based on risk-adjusted survival analysis.Abstract: CONCLUSIONS: This is the first multicenter analysis to merge data-driven RPS surgery volume thresholds to clinically meaningful sarcoma expert opinions. These findings will help inform national/international consensus recommendations, a practical volume threshold, trial design, and motivate evidence-based hospital referral. Copyright (c) 2019. Published by Elsevier Inc.

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