Sylvester Comprehensive Cancer Center

UM/Sylvester Surgeons Show High Volume Centers Have Better Outcomes Against Soft-Tissue Sarcomas

07.25.2007

Cancer patients who have surgery for soft-tissue sarcomas fare significantly better at high-volume academic medical centers than at lower volume community centers, even when the patients have more advanced disease. That’s the conclusion of a study authored by surgical oncologists at the University of Miami Sylvester Comprehensive Cancer Center in the Annals of Surgery. Soft tissue sarcomas can strike muscle, cartilage and GI tract tissue, and affect about 9,500 Americans a year according to the American Cancer Society. “Overall, survival was three months longer, and with a lower rate of amputation as another independent measure of success,” said Alan S. Livingstone, M.D., chairman of the Department of Surgery at the UM Miller School of Medicine.

Surgical resident Juan Gutierrez, M.D. and his colleagues studied data from the Florida state cancer registry from 1981 through 2001, examining 4,673 surgical procedures at 256 different medical centers across the state. Seven of those 256 centers, including the University/Jackson Memorial Medical Center, performed roughly one-third of the procedures – 1,504. “Patients treated at high volume centers have significantly better survival and functional outcomes that those treated at smaller centers,” said Gutierrez. Patients treated at the high-volume centers had better recoveries from surgery, longer survival and fewer amputations than those treated at low-volume centers. The outcome is particularly impressive given that patients referred to high volume academic centers like UM/Jackson had larger and more aggressive tumors, on average, than those treated at low-volume centers.

“Referrals of complex cancer patients requires for the referring center to realize that maybe it isn’t the best place to treat the disease,” said Leonidas G. Koniaris, M.D., Alan Livingstone Chair in Surgical Oncology. “On top of that, health plans may or may not let patients go out of that center to an academic center. And in some cases patients who are not considered candidates for surgery in the community may indeed be candidates at an academic center like the Miller School of Medicine.”

UM researchers looked at the 30-day and 90-day mortality rates, which are measures of surgical outcome, and also examined long-term outcome. Median survival at the high volume centers was 40 months versus 37 months for low volume centers. Treatment at a high volume center was an independent predictor of better outcome against soft-tissue sarcoma. UM/Sylvester surgical oncologists Fred Moffat, Dido Franceschi, and surgical chief resident Eduardo Perez were also authors on the study, which is published in the June, 2007 issue of Annals of Surgery and is available at this link: http://www.annalsofsurgery.com/pt/re/annos/abstract.00000658-200706000-00016.htm.

Previous studies involving Miller School surgeons have shown that high-volume experience leads to better outcomes, including a 2004 study on minimally invasive colorectal cancer surgeries published in the New England Journal of Medicine.

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