A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer
Autor: | N. Grivas, Guillaume Ploussard, Peter-Paul M. Willemse, Jakub Pecanka, Roderick C.N. van den Bergh, Maria De Santis, Thomas Van den Broeck, Nicolas Mottet, Thomas Wiegel, Olivier Rouvière, Jeremy Grummet, Silke Gillessen Sommer, Mithun Kailavasan, Daniela E. Oprea-Lager, Michael Lardas, Shane O'Hanlon, Cathy Yuhong Yuan, Henk G. van der Poel, Thomas B. Lam, Giorgio Gandaglia, Lisa Moris, Matthew Liew, Derya Tilki, Philip Cornford, Erik Briers, Ivo G. Schoots, Malcolm David Mason |
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Přispěvatelé: | Van den Broeck, T., Oprea-Lager, D., Moris, L., Kailavasan, M., Briers, E., Cornford, P., De Santis, M., Gandaglia, G., Gillessen Sommer, S., Grummet, J. P., Grivas, N., Lam, T. B. L., Lardas, M., Liew, M., Mason, M., O'Hanlon, S., Pecanka, J., Ploussard, G., Rouviere, O., Schoots, I. G., Tilki, D., van den Bergh, R. C. N., van der Poel, H., Wiegel, T., Willemse, P. -P., Yuan, C. Y., Mottet, N. |
Rok vydání: | 2021 |
Předmět: |
Male
Biochemical recurrence medicine.medical_specialty Blood transfusion Urology medicine.medical_treatment 030232 urology & nephrology MEDLINE Context (language use) Workload 03 medical and health sciences Prostate cancer 0302 clinical medicine SDG 3 - Good Health and Well-being Interquartile range Outcome Assessment Health Care Oncological outcomes Humans Medicine Prostatectomy Surgeons Surgeon volume business.industry General surgery Prostate Prostatic Neoplasms Perioperative medicine.disease Functional outcomes Hospitals Hospital volume Treatment Outcome Evidence synthesis 030220 oncology & carcinogenesis Systematic review Neoplasm Recurrence Local business Delivery of Health Care Hospitals High-Volume |
Zdroj: | van den Broeck, T, Oprea-Lager, D, Moris, L, Kailavasan, M, Briers, E, Cornford, P, de Santis, M, Gandaglia, G, Gillessen Sommer, S, Grummet, J P, Grivas, N, Lam, T B L, Lardas, M, Liew, M, Mason, M, O'Hanlon, S, Pecanka, J, Ploussard, G, Rouviere, O, Schoots, I G, Tilki, D, van den Bergh, R C N, van der Poel, H, Wiegel, T, Willemse, P-P, Yuan, C Y & Mottet, N 2021, ' A Systematic Review of the Impact of Surgeon and Hospital Caseload Volume on Oncological and Nononcological Outcomes After Radical Prostatectomy for Nonmetastatic Prostate Cancer ', European Urology, vol. 80, no. 5, pp. 531-545 . https://doi.org/10.1016/j.eururo.2021.04.028 |
ISSN: | 0302-2838 |
Popis: | 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. |
Databáze: | OpenAIRE |
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