When I tell a patient they need surgery, it’s not uncommon for them to ask how many times I’ve done that exact operation before. What they are really asking is if I have enough experience to perform their surgery.
This does not offend me in the least. In fact, they are correct to ask. That’s because there is a well-established relationship between surgical volumes and outcomes. More complex operations have better outcomes when the surgeon and hospital perform them more often.
That volume-outcome relationship pertains to two things:
- Surgeon volume – how many times that surgeon has done that specific surgery.
- Hospital surgical volume – how many times that hospital has done that specific surgery.
Surgical Volume = Outcome
There is strong evidence in scientific literature linking cancer surgical volume with patient outcomes. The more experience the surgeon has, the better the outcome. That’s particularly the case for complex cancer surgeries.
Many cancer surgeries require a high degree of technical expertise. Examples include surgeries for cancers of the esophagus, pancreas, rectum, and stomach.
At UPMC Hillman Cancer Center, we group cancer treatment by organ or system. We refer patients to surgical oncologists who deal with specific cancers, such as pancreatic cancer or esophageal cancer, instead of general surgeons. This results in deeper expertise in the management of those cancers, including the operations needed to remove them.
Surgeon volume leads to better technical skills and improved decision-making to choose the right operation for each patient. That could mean a laparoscopic approach for one person, open surgery for another, and robotic-assisted surgery for someone else to treat the same type of cancer. Our subspecialty experience helps us choose the right platform for the right patient.
Hospital Surgical Volume = Outcome
Hospital surgical volume also is associated with patient outcomes – especially for complex surgeries. A landmark study published in the New England Journal of Medicine in 2002 showed that high-volume centers have better outcomes and less mortality for four complex surgeries. That included two cancer surgeries — esophagectomy and pancreatectomy. This study was one of the earliest to show this critical volume-outcome relationship.
Hospital surgical volume is a key factor in outcomes from complex procedures. Some surgeries are associated with significant morbidity. This includes surgeries like hyperthermic intraperitoneal chemotherapy (HIPEC), esophagectomy, and Whipple procedures.
These surgeries come with a risk of serious complications that may occur in the postoperative setting, while the patient is recovering in the hospital. Patients often need many other subspecialties to recognize and treat complications immediately.
Such experience and resources—such as gastroenterology, interventional radiology, or intensive care unit (ICU) services — are more common at larger hospitals. These subspecialty services have advanced lifesaving procedures. They can rescue patients who might not survive at other low-volume medical centers.
The Multidisciplinary Approach
In general, solid tumors—such as those of the pancreas, colon, stomach, and esophagus — now are best treated in a multidisciplinary clinic setting. There, a variety of specialists collaborate to diagnose and treat patients with cancer, often in the same location and on the same day. Patients can get a one-stop-shop approach and not waste valuable treatment time by jumping from one specialist to another.
For example, the pancreatic cancer multidisciplinary clinic at UPMC Hillman includes specialists from:
- Pancreatic surgical oncology.
- Medical oncology.
- Radiation oncology.
- Palliative care.
- Nutrition.
- Genetic counseling.
- Behavioral health.
- Clinical trials.
Patients also have immediate access to gastroenterology for specialized tests and procedures. The presence of those subspecialties improves outcomes and the patient experience.
The multidisciplinary approach particularly improves outcomes for patients of lower socioeconomic status. Those patients may not have the resources or means to see many specialists over an extended period. This often results in delays in initiating treatment.
A recent UPMC study concluded that the multidisciplinary approach standardizes treatment decisions, eliminates disparities in surgical outcomes, and improves survival rates for patients of lesser financial means who have pancreatic cancer compared to those with more means.
Another recent UPMC study of 4,000 patients with pancreatic cancer reported similar outcomes.
In pancreatic cancer, only 20% of patients are surgical candidates. The other 80% of patients have metastatic disease at diagnosis. This means the cancer has already spread to other organs or into the bloodstream by the time it’s found, eliminating surgery as an option. This study showed that even patients with stage 4 pancreatic cancer who were of lower economic means still benefited from the multidisciplinary approach in terms of improved survival at the same rate as patients with more means.
In essence, the multidisciplinary approach levels the playing field.
Access to Research and Clinical Trials
Another key benefit of having surgery in a large-volume hospital is better access to the most innovative clinical trials.
UPMC Hillman, for instance, is a National Cancer Institute (NCI)-designated Comprehensive Cancer Center. We are one of only 53 in the U.S. and the only one in western Pennsylvania.
Our researchers collaborate with our clinician-scientists to advance the most promising laboratory studies into novel clinical trials. Patients receive early access to new treatments. Clinical trials can be critical for patients who are not candidates for surgery.
Large centers offer other options that can prolong and improve quality of life when surgery is not an option. All these options are more abundant in high-volume hospitals.
Access to Support Services
Support services also tend to be more available at large hospitals. This includes experienced nurses, physical therapists, occupational therapists, social workers, and rehabilitation therapists.
At UPMC Presbyterian, for instance, we have dedicated floors for patients by disease specialty. Our experienced nursing staff is familiar with the postoperative care needed for a particular operation and patient. This streamlines patient care, which serves to improve the patient experience and outcomes.
When More Is Better
The takeaway is when it comes to cancer surgeons and cancer hospitals, higher volume means more experience and better outcomes. UPMC hospitals perform more solid tumor surgeries than any hospital in the state.
To check surgical volumes at all Pennsylvania hospitals for 11 different types of cancers– including bladder, brain, breast, colon, esophageal, liver, lung, pancreatic, prostate, rectal, and stomach cancer – visit the PA HealthCare Cost Containment Council (PHC4) website. It can help patients make important health care decisions.
Editor's Note: This article was originally published on , and was last reviewed on .