Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion.
Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data with Consensus Expert Opinion.
- 2020
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
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. 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. 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. 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.
English
1072-7515
10.1016/j.jamcollsurg.2019.09.013 [doi] S1072-7515(19)32116-7 [pii]
*Retroperitoneal Neoplasms/pa [Pathology]
*Retroperitoneal Neoplasms/su [Surgery]
*Sarcoma/pa [Pathology]
*Sarcoma/su [Surgery]
*Soft Tissue Neoplasms/pa [Pathology]
*Soft Tissue Neoplasms/su [Surgery]
Aged
Consensus
Databases, Factual
Expert Testimony
Female
Humans
Male
Middle Aged
Retrospective Studies
Tumor Burden
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/General Surgery
Journal Article
Available online from MWHC library: 1997 - present, Available in print through MWHC library:1999-2007
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. 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. 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. 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.
English
1072-7515
10.1016/j.jamcollsurg.2019.09.013 [doi] S1072-7515(19)32116-7 [pii]
*Retroperitoneal Neoplasms/pa [Pathology]
*Retroperitoneal Neoplasms/su [Surgery]
*Sarcoma/pa [Pathology]
*Sarcoma/su [Surgery]
*Soft Tissue Neoplasms/pa [Pathology]
*Soft Tissue Neoplasms/su [Surgery]
Aged
Consensus
Databases, Factual
Expert Testimony
Female
Humans
Male
Middle Aged
Retrospective Studies
Tumor Burden
MedStar Health Research Institute
MedStar Washington Hospital Center
Surgery/General Surgery
Journal Article