Skip to main page content
U.S. flag

An official website of the United States government

Dot gov

The .gov means it’s official.
Federal government websites often end in .gov or .mil. Before sharing sensitive information, make sure you’re on a federal government site.

Https

The site is secure.
The https:// ensures that you are connecting to the official website and that any information you provide is encrypted and transmitted securely.

Access keys NCBI Homepage MyNCBI Homepage Main Content Main Navigation
. 2022 Dec 3;14(23):5984.
doi: 10.3390/cancers14235984.

The Impact of Facility Surgical Caseload Volumes on Survival Outcomes in Patients Undergoing Radical Cystectomy

Giovanni E Cacciamani  1 , Afsaneh Barzi  2 , Michael B Eppler  1 , Primo N Lara Jr  3 , Chong-Xian Pan  4 , Sumeet K Bhanvadia  1 , Parkash Gill  5 , Monish Aron  1 , Inderbir Gill  1 , Sarmad Sadeghi  6
Affiliations

The Impact of Facility Surgical Caseload Volumes on Survival Outcomes in Patients Undergoing Radical Cystectomy

Giovanni E Cacciamani et al. Cancers (Basel). .

Abstract

The role of surgical experience and its impact on the survival requires further investigation. A cohort of patients undergoing radical cystectomy or anterior pelvic exenteration for localized bladder cancer between 2006 and 2013 at 1143 facilities across the United States was identified using the National Cancer Database and analyzed. Using overall survival (OS) as the primary outcome, the relationship between facility annual caseload (FAC) and facility annual surgical caseload (FASC) for those undergoing curative surgery was examined. Four volume groups (VG) depending on caseload using both FAC and FASC were defined. These included VG1: below 50th percentile, VG2: 50th−74th percentile, VG3: 75th−89th percentile, and VG4: 90th and above. Between 2006 and 2013, 27,272 patients underwent surgery for localized bladder cancer. The median OS was 59.66 months (95% CI: 57.79−61.77). OS improved significantly as caseload increased. The unadjusted median OS difference between VG1 and VG4 was 15.35 months (64.3 vs. 48.95 months, HR 1.19 95% CI: 1.13−1.25, p < 0.001) for FAC. This figure was 19.84 months (66.89 vs. 47.05 months, HR 1.25 95% CI: 1.18−1.32, p < 0.0001) for FASC. This analysis revealed a significant and clinically important survival advantage for curative bladder cancer surgery at highly experienced centers.

Keywords: NCDB; bladder cancer; facility caseload; national cancer database; oncologic outcomes; overall survival; pelvic exenteration; radical cystectomy.

PubMed Disclaimer

Conflict of interest statement

The authors declare no conflict of interest.

Figures

Figure 1
Figure 1
Cohort selection process. As the focus of this analysis and the hypothesis tested here is the impact of caseload on the oncologic outcome of bladder cancer surgery, the 90-day mortality, which is largely reflective of death due to surgical complications rather than progressive disease, is excluded from the analysis. Similarly, this analysis is focused on curative intent surgery for bladder cancer, and therefore, patients with known metastatic disease who underwent surgery primarily for palliative reasons are excluded.
Figure 2
Figure 2
Multivariable logistic regression analysis of predictors of mortality based on (A) facility annual surgical caseload (FASC) and (B) facility annual caseload (FAC). HR: hazard ratio; SM: surgical margin; VG: volume group; * refers to the combination of the following: NI: neoadjuvant chemo indicated; NG: neoadjuvant chemo given; AI: adjuvant chemo indicated; AG: adjuvant chemo given. ** These are patients who received neoadjuvant chemo without a clear indication, but post operatively based on pathology findings would have qualified for adjuvant chemo. (0) no, (1) yes.
Figure 3
Figure 3
Survival curves adjusted by caseload volumes. FAC: facility annual caseload; FASC: facility annual surgical caseload. HR: hazard ratio; SM: surgical margin; VG: volume group; * refers to the combination of the following: NI: neoadjuvant chemo indicated; NG: neoadjuvant chemo given; AI: adjuvant chemo indicated; AG: adjuvant chemo given. ** These are patients who received neo-adjuvant chemo without a clear indication, but post operatively based on pathology findings would have qualified for adjuvant chemo. (0) no, (1) yes.
See this image and copyright information in PMC

Similar articles

See all similar articles

Cited by

References

    1. Joudi F.N., Konety B.R. The impact of provider volume on outcomes from urological cancer therapy. J. Urol. 2005;174:432–438. doi: 10.1097/01.ju.0000165340.53381.48. - DOI - PubMed
    1. Kulkarni G.S., Urbach D.R., Austin P.C., Fleshner N.E., Laupacis A. Higher surgeon and hospital volume improves long-term survival after radical cystectomy. Cancer. 2013;119:3546–3554. doi: 10.1002/cncr.28235. - DOI - PubMed
    1. Morgan T.M., Barocas D.A., Keegan K.A., Cookson M.S., Chang S.S., Ni S., Clark P.E., Smith J.A., Jr., Penson D.F. Volume outcomes of cystectomy--is it the surgeon or the setting? J. Urol. 2012;188:2139–2144. doi: 10.1016/j.juro.2012.08.042. - DOI - PubMed
    1. Nuttall M., Van Der Meulen J., Phillips N., Sharpin C., Gillatt D., McIntosh G., Emberton M. A systematic review and critique of the literature relating hospital or surgeon volume to health outcomes for 3 urological cancer procedures. (6 Pt 1)J. Urol. 2004;172:2145–2152. doi: 10.1097/01.ju.0000140257.05714.45. - DOI - PubMed
    1. Wilt T.J., Shamliyan T.A., Taylor B.C., MacDonald R., Kane R.L. Association between hospital and surgeon radical prostatectomy volume and patient outcomes: A systematic review. J. Urol. 2008;180:820–828; discussion 8–9. doi: 10.1016/j.juro.2008.05.010. - DOI - PubMed

LinkOut - more resources