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Invited Commentary
August 14, 2019

Volume Standards for High-risk Cancer Surgery

Author Affiliations
  • 1Division of Surgical Oncology, Department of Surgery, City of Hope National Medical Center, Duarte, California
  • 2Department of Medicine and Surgery, University of North Carolina at Chapel Hill, Chapel Hill
JAMA Surg. Published online August 14, 2019. doi:10.1001/jamasurg.2019.3018

Hospital volume has a major effect on short-term and long-term outcomes for complex cancer surgery.1 For pancreatic cancer, as much as a 6% perioperative survival advantage can be gained by just traveling across town in many metropolitan areas.1 The cost of taking a car service to a high-volume center is trivial compared with that of chemotherapies. The survival advantage of this neoadjuvant “Lyft therapy” is often more than the survival benefit gained from adjuvant chemotherapy.2 This is the reason why in many nations, centralization of complex surgery is mandated by law and enforced by health care financing.3 In the United States, there is no such legislative mandate. The welfare of patients with cancer has been left to the goodwill of hospitals, health care systems, and under scrutiny mainly by advocacy groups. The article by Sheetz et al4 in this issue of JAMA Surgery would indicate that this voluntary centralization effort for complex surgery is failing. Only 23% of the 47 318 pancreatectomies performed between 2006 and 2016 in the Medicare Provider Analysis and Review files were performed in high-volume centers. Further, undergoing a surgical procedure in a low-volume center had a 2.3% higher 30-day mortality.4

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