Abstract
BackgroundRetroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. However, it is not clearly demonstrated if clinical outcome is more influenced by Center Case Volume (CCV) or by Surgeon Case Volume (SCV). The aim of this study is to retrospectively explore the relationship between CCV and SCV and the quality of surgery in a wide region of Northern Italy.MethodsWe retrospectively collected data about patients M0 surgically treated for RPSs in 22 different hospitals from 2006 to 2011, dividing them in two hospital groups according to sarcoma clinical activity volume (HCV, high case volume or LCV, low case volume hospitals). The HCV group (> 100 sarcomas observed per year) included a Comprehensive Cancer Center (HVCCC) with a high sarcoma SCV (> 20 cases/year), and a Tertiary Academic Hospital (HVTCA) with multiple surgeon teams and a low sarcoma SCV (≤ 5 cases/year for each involved surgeon). All other hospitals were included in the LCV group (< 100 sarcomas observed per year).ResultsData regarding 138 patients were collected. Patients coming from LCV hospitals (66) were excluded from the analysis as prognostic data were frequently not available. Among the 72 remaining cases of HCV hospitals 60% of cases had R0/R1 margins, with a more favorable distribution of R0/R1 versus R2 in HVCCC compared to HVTCA.ConclusionsIn HCV hospitals, sarcoma SCV may significantly influence RPS treatment quality. In low-volume centers surgical reports can often miss important prognostic issues and surgical quality is generally poor.
Highlights
Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers
In our study patients data retrieved from different hospitals were split in two groups according to their yearly sarcoma caseload, adopting the 100 cases/year cut-off rule suggested by NICE [9] (Fig. 1)
No useful informations were available concerning tumor diameter, preoperative biopsy, margins evaluation and FNLCLCC grading. Data from this latter group was not considered in the subsequent analysis, which has been conducted only on HTVCA and high volume Comprehensive Cancer Center (HVCCC) patients
Summary
Retroperitoneal sarcomas (RPS) should be surgically managed in specialized sarcoma centers. Given the low incidence of RPS, individual hospitals and Sandrucci et al Clin Sarcoma Res (2018) 8:3 surgeons generally observe very few cases; for this reason available guidelines and consensus-papers state that, as a complex and rare disease, every case of RPS should be referred to a specialized sarcoma center and managed by a multidisciplinary team [5,6,7]. It is unclear what factor(s), for example, case volume, surgeon activity volume, hospital type, or the availability of adjuvant therapies, is/are the principal driver(s) of improved outcomes
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