Long-Term Survival Is Superior After Resection for Cancer in High-Volume Centers

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Abstract
A number of studies have demonstrated that surgical resection at high-volume centers is associated with improved short-term perioperative outcome. Whether long-term results after resection of visceral malignancies are superior at high-volume centers is largely unknown. All patients who were subjected to pancreatectomy or hepatectomy for cancer in the years 1995 and 1996 were identified in the National Medicare database. Data extracted and examined include demographics, comorbidities, and long-term survival. All survival was confirmed through 2001, providing actual 5-year survival. Long-term survival was examined as related to hospital volume. In the study period, there were 2592 pancreatectomies and 3734 hepatectomies performed at 1101 and 1284 institutions, respectively. High-volume center was defined as >25 cases/y. By this definition, there were 10 high-volume centers for pancreatectomy and 12 centers for hepatectomy performing 11% (n = 291) of the pancreatectomies and 12% (n = 474) of the hepatectomies in this study period. Comparison by log-rank demonstrated superior survival for patients resected at high-volume centers (pancreatectomy: P = 0.001; hepatectomy: P = 0.02). This was confirmed by multivariate analysis. All analyses included an adjustment for within-center correlation. Superior long-term survival is associated with complex visceral resections for cancer at high-volume centers.