Abstract：
BACKGROUND: The concept of surgical centralization is becoming more and more accepted for specific surgical procedures.
OBJECTIVE: The aim of this study was to evaluate the relationship between procedure volume and the outcomes of surgical small intestine (SI) neuroendocrine tumor (NET) resections.
METHODS: We conducted a retrospective national study that included patients who underwent SI-NET resection between 2019 and 2021. A high-volume center (hvC) was defined as a center that performed more than five SI-NET resections per year. The quality of the surgical resections was evaluated between hvCs and low-volume centers (lvCs) by comparing the number of resected lymph nodes (LNs) as the primary endpoint.
RESULTS: A total of 157 patients underwent surgery in 33 centers: 90 patients in four hvCs and 67 patients in 29 lvCs. Laparotomy was more often performed in hvCs (85.6% vs. 59.7%; p < 0.001), as was right hemicolectomy (64.4% vs. 38.8%; p < 0.001), whereas limited ileocolic resection was performed in 18% of patients in lvCs versus none in hvCs. A bi-digital palpation of the entire SI length (95.6% vs. 34.3%, p < 0.001), a cholecystectomy (93.3% vs. 14.9%; p < 0.001), and a mesenteric mass resection (70% vs. 35.8%; p < 0.001) were more often performed in hvCs. The proportion of patients with ≥8 LNs resected was significantly higher (96.3% vs. 65.1%; p < 0.001) in hvCs compared with lvCs, as was the proportion of patients with ≥12 LNs resected (87.8% vs. 52.4%). Furthermore, the number of patients with multiple SI-NETs was higher in the hvC group compared with the lvC group (43.3% vs. 25.4%), as were the number of tumors in those patients (median of 7 vs. 2; p < 0.001).
CONCLUSIONS: Optimal SI-NET resection was significantly more often performed in hvCs. Centralization of surgical care of SI-NETs is recommended.
OBJECTIVE: The aim of this study was to evaluate the relationship between procedure volume and the outcomes of surgical small intestine (SI) neuroendocrine tumor (NET) resections.
METHODS: We conducted a retrospective national study that included patients who underwent SI-NET resection between 2019 and 2021. A high-volume center (hvC) was defined as a center that performed more than five SI-NET resections per year. The quality of the surgical resections was evaluated between hvCs and low-volume centers (lvCs) by comparing the number of resected lymph nodes (LNs) as the primary endpoint.
RESULTS: A total of 157 patients underwent surgery in 33 centers: 90 patients in four hvCs and 67 patients in 29 lvCs. Laparotomy was more often performed in hvCs (85.6% vs. 59.7%; p < 0.001), as was right hemicolectomy (64.4% vs. 38.8%; p < 0.001), whereas limited ileocolic resection was performed in 18% of patients in lvCs versus none in hvCs. A bi-digital palpation of the entire SI length (95.6% vs. 34.3%, p < 0.001), a cholecystectomy (93.3% vs. 14.9%; p < 0.001), and a mesenteric mass resection (70% vs. 35.8%; p < 0.001) were more often performed in hvCs. The proportion of patients with ≥8 LNs resected was significantly higher (96.3% vs. 65.1%; p < 0.001) in hvCs compared with lvCs, as was the proportion of patients with ≥12 LNs resected (87.8% vs. 52.4%). Furthermore, the number of patients with multiple SI-NETs was higher in the hvC group compared with the lvC group (43.3% vs. 25.4%), as were the number of tumors in those patients (median of 7 vs. 2; p < 0.001).
CONCLUSIONS: Optimal SI-NET resection was significantly more often performed in hvCs. Centralization of surgical care of SI-NETs is recommended.
摘要：
背景：手术集中化的概念对于特定的外科手术越来越被接受。
目的：本研究的目的是评估手术体积与手术小肠（SI）神经内分泌肿瘤（NET）切除结果之间的关系。
方法：我们进行了一项回顾性全国研究，纳入了2019年至2021年接受SI-NET切除术的患者。大批量中心（hvC）被定义为每年进行五次以上SI-NET切除的中心。通过比较切除的淋巴结（LN）的数量作为主要终点，在hvCs和低容量中心（lvCs）之间评估手术切除的质量。
结果：共有157名患者在33个中心接受了手术：90名患者在4个hvCs中，67名患者在29个lvCs中。腹腔镜手术在hvCs中更常见（85.6％与59.7%；p<0.001)，右半结肠切除术(64.4%vs.38.8%；p<0.001)，而在lvCs中，有18％的患者进行了限制性回肠结肠切除术，而在hvCs中没有。整个SI长度的双数字触诊(95.6%与34.3%,p<0.001)，胆囊切除术(93.3%vs.14.9%；p<0.001)，和肠系膜肿块切除术(70%vs.35.8%；p<0.001)在hvCs中更常见。切除≥8个LN的患者比例明显更高(96.3%vs.65.1%；p<0.001)在HVC中与LVC相比，切除≥12LN的患者比例(87.8%vs.52.4%）。此外，与lvC组相比，hvC组具有多个SI-NETs的患者人数更高(43.3%vs.25.4%），这些患者的肿瘤数量(中位数为7vs.2；p<0.001）。
结论：最佳SI-NET切除在hvCs中明显更常见。建议将SI-NET的外科护理集中。
目的：本研究的目的是评估手术体积与手术小肠（SI）神经内分泌肿瘤（NET）切除结果之间的关系。
方法：我们进行了一项回顾性全国研究，纳入了2019年至2021年接受SI-NET切除术的患者。大批量中心（hvC）被定义为每年进行五次以上SI-NET切除的中心。通过比较切除的淋巴结（LN）的数量作为主要终点，在hvCs和低容量中心（lvCs）之间评估手术切除的质量。
结果：共有157名患者在33个中心接受了手术：90名患者在4个hvCs中，67名患者在29个lvCs中。腹腔镜手术在hvCs中更常见（85.6％与59.7%；p<0.001)，右半结肠切除术(64.4%vs.38.8%；p<0.001)，而在lvCs中，有18％的患者进行了限制性回肠结肠切除术，而在hvCs中没有。整个SI长度的双数字触诊(95.6%与34.3%,p<0.001)，胆囊切除术(93.3%vs.14.9%；p<0.001)，和肠系膜肿块切除术(70%vs.35.8%；p<0.001)在hvCs中更常见。切除≥8个LN的患者比例明显更高(96.3%vs.65.1%；p<0.001)在HVC中与LVC相比，切除≥12LN的患者比例(87.8%vs.52.4%）。此外，与lvC组相比，hvC组具有多个SI-NETs的患者人数更高(43.3%vs.25.4%），这些患者的肿瘤数量(中位数为7vs.2；p<0.001）。
结论：最佳SI-NET切除在hvCs中明显更常见。建议将SI-NET的外科护理集中。
