TY - JOUR
T1 - What provider volumes and characteristics are appropriate for gastric cancer resection? Results of an international RAND/UCLA expert panel
AU - Dixon, Matthew
AU - Mahar, Alyson
AU - Paszat, Lawrence
AU - McLeod, Robin
AU - Law, Calvin
AU - Swallow, Carol
AU - Helyer, Lucy
AU - Seeveratnam, Rajini
AU - Cardoso, Roberta
AU - Bekaii-Saab, Tanios
AU - Chau, Ian
AU - Church, Neal
AU - Coit, Daniel
AU - Crane, Christopher H.
AU - Earle, Craig
AU - Mansfield, Paul
AU - Marcon, Norman
AU - Miner, Thomas
AU - Noh, Sung Hoon
AU - Porter, Geoff
AU - Posner, Mitchell C.
AU - Prachand, Vivek
AU - Sano, Takeshi
AU - Van De Velde, Cornelis J.H.
AU - Wong, Sandra
AU - Coburn, Natalie
N1 - Funding Information:
This research is funded by the Canadian Cancer Society (grant # 019325 ). Dr. Coburn (Career Scientist Award) and Dr. Paszat have received funding provided by Cancer Care Ontario and the Ontario Institute for Cancer Research (through funding provided by the Ministry of Health and Long-Term Care and the Ministry of Research & Innovation of the Government of Ontario). Dr. Law is supported by the Hanna Family Research Chair in Surgical Oncology . Ian Chau would like to acknowledge the National Health Service funding to the National Institute for Health Research's Biomedical Research Centre. Dr. Earle is supported by the Ontario Institute for Cancer Research, funded by the Government of Ontario . The authors have no conflicts of interest to disclose.
PY - 2013/11
Y1 - 2013/11
N2 - Background: A relationship between higher volume providers and improved outcomes has been suggested by some studies and has been used to construct guidelines for many diseases. For gastric cancer (GC), however, optimal volume cutoffs are not clear. Methods: A multidisciplinary expert panel of 16 physicians from 6 countries scored 120 scenarios regarding provider characteristics for gastric resections for GC. Appropriateness of scenarios was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. Agreement was reached when 12 of 16 panelists scored the statement similarly. Appropriate scenarios agreed on were scored subsequently for necessity. Results: Surgeon and hospital practice volume scenarios were evaluated. The panel felt it was inappropriate for surgeons doing ≤2 GC cases per year to perform a multivisceral resection (MVR), D2 lymphadenectomy (D2-LND), or laparoscopic total gastrectomy, and ≤6 GC cases per year for an MVR involving a pancreatoduodenectomy (MVR-PD), or endoscopic mucosal resections (EMR). It was considered appropriate for surgeons doing ≥11 GC cases per year to perform open gastrectomy or D2-LND, and ≥20 GC cases per year for any MVR, laparoscopic gastrectomy, or EMR. For hospitals, it was considered inappropriate for hospitals managing ≤4 GC cases per year to perform D2-LND or laparoscopic total gastrectomy, and ≤10 GC cases per year, for MVR-PD or EMR. Hospital volumes ≥21 cases per year was considered appropriate for any GC procedure. It was inappropriate for an MVR to be performed in a hospital without interventional radiology services and for a MVR-PD in a hospital with no level I intensive care unit. Conclusion: Appropriate and inappropriate provider volumes for a variety of gastric procedures have been defined by an international expert panel.
AB - Background: A relationship between higher volume providers and improved outcomes has been suggested by some studies and has been used to construct guidelines for many diseases. For gastric cancer (GC), however, optimal volume cutoffs are not clear. Methods: A multidisciplinary expert panel of 16 physicians from 6 countries scored 120 scenarios regarding provider characteristics for gastric resections for GC. Appropriateness of scenarios was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. Agreement was reached when 12 of 16 panelists scored the statement similarly. Appropriate scenarios agreed on were scored subsequently for necessity. Results: Surgeon and hospital practice volume scenarios were evaluated. The panel felt it was inappropriate for surgeons doing ≤2 GC cases per year to perform a multivisceral resection (MVR), D2 lymphadenectomy (D2-LND), or laparoscopic total gastrectomy, and ≤6 GC cases per year for an MVR involving a pancreatoduodenectomy (MVR-PD), or endoscopic mucosal resections (EMR). It was considered appropriate for surgeons doing ≥11 GC cases per year to perform open gastrectomy or D2-LND, and ≥20 GC cases per year for any MVR, laparoscopic gastrectomy, or EMR. For hospitals, it was considered inappropriate for hospitals managing ≤4 GC cases per year to perform D2-LND or laparoscopic total gastrectomy, and ≤10 GC cases per year, for MVR-PD or EMR. Hospital volumes ≥21 cases per year was considered appropriate for any GC procedure. It was inappropriate for an MVR to be performed in a hospital without interventional radiology services and for a MVR-PD in a hospital with no level I intensive care unit. Conclusion: Appropriate and inappropriate provider volumes for a variety of gastric procedures have been defined by an international expert panel.
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U2 - 10.1016/j.surg.2013.05.021
DO - 10.1016/j.surg.2013.05.021
M3 - Article
C2 - 24075275
AN - SCOPUS:84886094617
SN - 0039-6060
VL - 154
SP - 1100
EP - 1109
JO - Surgery (United States)
JF - Surgery (United States)
IS - 5
ER -
