Regionalization of Surgery for Retroperitoneal Sarcoma Surgery to High-Volume Hospitals


Key Points

  • During the study period, 9.6% patients with retroperitoneal sarcoma underwent surgery at high-volume hospitals.
  • The rate of regionalization of these surgeries to high-volume hospitals was 30.5% of the rate of pancreatic cancer surgery regionalization to high-volume hospitals.  

In a study reported in the Journal of Oncology Practice, Villano et al found that regionalization of retroperitoneal sarcoma surgery—recognized as a complex cancer surgery—to high-volume hospitals has been slower than that observed for similarly complex pancreatic cancer surgery over the past decade.

The study involved data on 70,763 patients who underwent surgical resection for retroperitoneal sarcoma (n = 8,721) or PC (n = 62,042) from the National Cancer Database for 2004 to 2015. The top decile for procedures per year was used to define a high-volume hospital: ≥ 10 procedures for retroperitoneal sarcoma surgery and ≥ 68 procedures for pancreatic cancer surgery.

Proportion of Surgeries at High-Volume Hospitals

During the study period, 9.6% of patients with retroperitoneal sarcoma underwent surgery at high-volume hospitals. Patients who received surgery at high-volume hospitals were more likely to be white, privately insured, more highly educated, and wealthier.

Over the study period, the odds ratio of undergoing retroperitoneal sarcoma surgery compared with pancreatic cancer surgery at high-volume hospitals was 0.65 (P < .05). Time trend analysis showed that the rate of retroperitoneal sarcoma surgery regionalization to high-volume hospitals increased at 30.5% of the increasing regionalization rate for pancreatic cancer surgery during the study period (1.017 vs 1.056, P < .001).

Findings were similar in analyses using several different hospital volume thresholds and hospital volume as a continuous variable. In unadjusted models, the proportion of patients undergoing retroperitoneal sarcoma surgery at high-volume hospitals increased from 6.4% in 2004 to 12.9% in 2015. The investigators noted that hospitals with high volume for both retroperitoneal sarcoma and pancreatic cancer surgeries performed significantly more annual procedures and had better rates of 30- and 90-day mortality vs hospitals that had a high volume for either cancer alone.

The investigators concluded, “Results from this retrospective multi-institutional analysis uncovered a lag in the regionalization of surgery for [retroperitoneal sarcoma] compared with [pancreatic cancer] surgery. These findings reinforce the call to regionalize surgery for [retroperitoneal sarcoma to high-volume hospitals] in a manner that is similar to that of other procedures in complex cancer surgery.”

Waddah B. Al-Refaie, MD, of the Department of Surgery, MedStar-Georgetown University Hospital, Lombardi Cancer Center, is the corresponding author for the Journal of Oncology Practice article.

Disclosure: The study was supported by a grant from the Georgetown-Howard Universities Center for Clinical and Translational Science and The Lee Folger Foundation. The study authors’ full disclosures can be found at

The content in this post has not been reviewed by the American Society of Clinical Oncology, Inc. (ASCO®) and does not necessarily reflect the ideas and opinions of ASCO®.