Elsevier

Surgery

Volume 145, Issue 1, January 2009, Pages 76-85
Surgery

Original Communication
Cancer care in the pediatric surgical patient: A paradigm to abolish volume-outcome disparities in surgery

https://doi.org/10.1016/j.surg.2008.08.011Get rights and content

Background

The objective of this study was to define the prognostic significance of hospital surgical volume on outcomes for pediatric neuroblastoma and Wilms tumor.

Methods

The Florida Cancer Data System was examined for all pediatric patients treated between 1981 and 2004.

Results

Of the 869 patients with neuroblastoma identified, 463 were treated at 5 high-volume centers (HVC) and 406 were treated at 61 low-volume centers (LVC). There were no differences in sex, age at diagnosis, race, ethnicity, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (70.6% and 67.7% at HVC vs 69.3% and 65.2% at LVC, P = .243). Multivariate analysis identified age at diagnosis and tumor stage as independent prognostic factors. Of the 790 patients with Wilms tumor identified, 395 were treated at 5 HVC and 395 were treated at 50 LVC. There were no differences in sex, age of diagnosis, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (91.3% and 89.9% at HVC vs 89.7% and 88.5% at LVC, P = .698). Multivariate analysis identified ethnicity, tumor stage, and use of chemotherapy as independent prognostic factors.

Conclusion

Survival rates for patients with neuroblastoma and Wilms tumor are unrelated to the hospital surgical volume or patient race. This result stands in stark contrast to a variety of adult malignancies. Models used for pediatric patient care for cancer may provide insight into ways to improve the treatment of adult patients in need of complex cancer care.

Section snippets

Methods

Florida is the fourth most populous state in the country. Since 1981, the Florida Cancer Data System (FCDS) has collected information on all cancer cases in the state of Florida, which comprises approximately 6% of the U.S. population. This cancer registry currently includes over 2.7 million records. In 1994, the FCDS became part of the National Program of Cancer Registries (NPCR), which is administered by the Centers for Disease Control and Prevention (CDC). Over 96,000 reportable invasive

Hospital volume

From 1981 to 2004, a total of 66 and 55 centers in Florida treated at least 1 patient 18 years of age or younger with the diagnosis of NBL or WT, respectively (Table I). Of the 869 patients with NBL identified, 463 were treated at 5 HVC and 406 were treated at 61 LVC using the previously described case-volume stratification (Fig 1). Similarly, for the 790 patients with WT identified, 395 were treated at 5 HVC and 395 were treated at 50 LVC.

Patient demographics and clinical data

During the 24-year study period, there were a total of

Discussion

There is a plethora of reports in the medical literature supporting a direct correlation between procedural volume and treatment outcome. A systematic review and critique of the literature published by Halm et al24 in 2002 revealed 135 studies. More than 70% of studies examining hospital volume reported a statistically significant association between greater volume and improved outcomes. Many of these reports focus on cancer-related procedures, but the effect of volume on mortality has also

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