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A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer
T. Van den Broeck, D. Oprea-Lager, L. Moris, M. Kailavasan, E. Briers, P. Cornford, M. De Santis, G. Gandaglia, S. Gillessen Sommer, JP. Grummet, N. Grivas, TBL. Lam, M. Lardas, M. Liew, M. Mason, S. O'Hanlon, J. Pecanka, G. Ploussard, O....
Jazyk angličtina Země Švýcarsko
Typ dokumentu časopisecké články, přehledy, systematický přehled
- MeSH
- chirurgové zásobování a distribuce MeSH
- hodnocení výsledků zdravotní péče MeSH
- lidé MeSH
- lokální recidiva nádoru MeSH
- nádory prostaty chirurgie MeSH
- nemocnice MeSH
- poskytování zdravotní péče normy MeSH
- pracovní zátěž MeSH
- prostata chirurgie MeSH
- prostatektomie škodlivé účinky MeSH
- specializovaná centra se zvyšujícím se počtem výkonů a tím zvyšující se kvalitou léčby MeSH
- výsledek terapie MeSH
- Check Tag
- lidé MeSH
- mužské pohlaví MeSH
- Publikační typ
- časopisecké články MeSH
- přehledy MeSH
- systematický přehled MeSH
CONTEXT: The impact of surgeon and hospital volume on outcomes after radical prostatectomy (RP) for localised prostate cancer (PCa) remains unknown. OBJECTIVE: To perform a systematic review on the association between surgeon or hospital volume and oncological and nononcological outcomes following RP for PCa. EVIDENCE ACQUISITION: Medline, Medline In-Process, Embase, and the Cochrane Central Register of Controlled Trials were searched. All comparative studies for nonmetastatic PCa patients treated with RP published between January 1990 and May 2020 were included. For inclusion, studies had to compare hospital or surgeon volume, defined as caseload per unit time. Main outcomes included oncological (including prostate-specific antigen persistence, positive surgical margin [PSM], biochemical recurrence, local and distant recurrence, and cancer-specific and overall survival) and nononcological (perioperative complications including need for blood transfusion, conversion to open procedure and within 90-d death, and continence and erectile function) outcomes. Risk of bias (RoB) and confounding assessments were undertaken. Both a narrative and a quantitative synthesis were planned if the data allowed. EVIDENCE SYNTHESIS: Sixty retrospective comparative studies were included. Generally, increasing surgeon and hospital volumes were associated with lower rates of mortality, PSM, adjuvant or salvage therapies, and perioperative complications. Combining group size cut-offs as used in the included studies, the median threshold for hospital volume at which outcomes start to diverge is 86 (interquartile range [IQR] 35-100) cases per year. In addition, above this threshold, the higher the caseload, the better the outcomes, especially for PSM. RoB and confounding were high for most domains. CONCLUSIONS: Higher surgeon and hospital volumes for RP are associated with lower rates of PSMs, adjuvant or salvage therapies, and perioperative complications. This association becomes apparent from a caseload of >86 (IQR 35-100) per year and may further improve hereafter. Both high- and low-volume centres should measure their outcomes, make them publicly available, and improve their quality of care if needed. PATIENT SUMMARY: We reviewed the literature to determine whether the number of prostate cancer operations (radical prostatectomy) performed in a hospital affects the outcomes of surgery. We found that, overall, hospitals with a higher number of operations per year have better outcomes in terms of cancer recurrence and complications during or after hospitalisation. However, it must be noted that surgeons working in hospitals with lower annual operations can still achieve similar or even better outcomes. Therefore, making hospital's outcome data publicly available should be promoted internationally, so that patients can make an informed decision where they want to be treated.
Department of Medicine Health Science Centre McMaster University Hamilton Ontario Canada
Department of Radiation Oncology University Hospital Ulm Ulm Germany
Department of Radiology Netherlands Cancer Institute Amsterdam The Netherlands
Department of Surgery Central Clinical School Monash University Australia
Department of Urology Aberdeen Royal Infirmary Aberdeen UK
Department of Urology Antonius Hospital Utrecht The Netherlands
Department of Urology Charité University Hospital Berlin Germany
Department of Urology Hatzikosta General Hospital Ioannina Greece
Department of Urology Liverpool University Hospitals Liverpool UK
Department of Urology Medical University of Vienna Vienna Austria
Department of Urology Metropolitan General Hospital Athens Greece
Department of Urology Netherlands Cancer Institute Amsterdam The Netherlands
Department of Urology University Hospital Hamburg Eppendorf Hamburg Germany
Department of Urology University Hospital St Etienne France
Department of Urology University Hospitals Leuven Leuven Belgium
Department of Urology Wrightington Wigan and Leigh Teaching Hospitals NHS Foundation Trust Wigan UK
La Croix du Sud Hospital Quint Fonsegrives France
Leicester City Hospital Leicester UK
Martini Klinik Prostate Cancer Centre Hamburg Germany
Medicine for Older People Saint Vincent's University Hospital Dublin Ireland
Oncology Institute of Southern Switzerland Bellinzona Switzerland
Citace poskytuje Crossref.org
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