Abstract：
Despite lacking clinical data, the Dutch government is considering increasing the minimum annual surgical volume per center from twenty to fifty cytoreductive surgeries (CRS) for advanced-stage ovarian cancer (OC). This study aims to evaluate whether this increase is warranted.
This population-based study included all CRS for FIGO-stage IIB-IVB OC registered in eighteen Dutch hospitals between 2019 and 2022. Short-term outcomes included result of CRS, length of stay, severe complications, 30-day mortality, time to adjuvant chemotherapy, and textbook outcome. Patients were stratified by annual volume: low-volume (nine hospitals, <25), medium-volume (four hospitals, 29-37), and high-volume (five hospitals, 54-84). Descriptive statistics and multilevel logistic regressions were used to assess the (case-mix adjusted) associations of surgical volume and outcomes.
A total of 1646 interval CRS (iCRS) and 789 primary CRS (pCRS) were included. No associations were found between surgical volume and different outcomes in the iCRS cohort. In the pCRS cohort, high-volume was associated with increased complete CRS rates (aOR 1.9, 95%-CI 1.2-3.1, p = 0.010). Furthermore, high-volume was associated with increased severe complication rates (aOR 2.3, 1.1-4.6, 95%-CI 1.3-4.2, p = 0.022) and prolonged length of stay (aOR 2.3, 95%-CI 1.3-4.2, p = 0.005). 30-day mortality, time to adjuvant chemotherapy, and textbook outcome were not associated with surgical volume in the pCRS cohort. Subgroup analyses (FIGO-stage IIIC-IVB) showed similar results. Various case-mix factors significantly impacted outcomes, warranting case-mix adjustment.
Our analyses do not support further centralization of iCRS for advanced-stage OC. High-volume was associated with higher complete pCRS, suggesting either a more accurate selection in these hospitals or a more aggressive approach. The higher completeness rates were at the expense of higher severe complications and prolonged admissions.
This population-based study included all CRS for FIGO-stage IIB-IVB OC registered in eighteen Dutch hospitals between 2019 and 2022. Short-term outcomes included result of CRS, length of stay, severe complications, 30-day mortality, time to adjuvant chemotherapy, and textbook outcome. Patients were stratified by annual volume: low-volume (nine hospitals, <25), medium-volume (four hospitals, 29-37), and high-volume (five hospitals, 54-84). Descriptive statistics and multilevel logistic regressions were used to assess the (case-mix adjusted) associations of surgical volume and outcomes.
A total of 1646 interval CRS (iCRS) and 789 primary CRS (pCRS) were included. No associations were found between surgical volume and different outcomes in the iCRS cohort. In the pCRS cohort, high-volume was associated with increased complete CRS rates (aOR 1.9, 95%-CI 1.2-3.1, p = 0.010). Furthermore, high-volume was associated with increased severe complication rates (aOR 2.3, 1.1-4.6, 95%-CI 1.3-4.2, p = 0.022) and prolonged length of stay (aOR 2.3, 95%-CI 1.3-4.2, p = 0.005). 30-day mortality, time to adjuvant chemotherapy, and textbook outcome were not associated with surgical volume in the pCRS cohort. Subgroup analyses (FIGO-stage IIIC-IVB) showed similar results. Various case-mix factors significantly impacted outcomes, warranting case-mix adjustment.
Our analyses do not support further centralization of iCRS for advanced-stage OC. High-volume was associated with higher complete pCRS, suggesting either a more accurate selection in these hospitals or a more aggressive approach. The higher completeness rates were at the expense of higher severe complications and prolonged admissions.
摘要：
目的：尽管缺乏临床数据，荷兰政府正在考虑将每个中心的最小年手术量从20例增加到50例晚期卵巢癌（OC）的细胞减灭术（CRS）。这项研究旨在评估这种增加是否有必要。
方法：这项基于人群的研究包括2019年至2022年间在18家荷兰医院注册的FIGO阶段IIB-IVBOC的所有CRS。短期结果包括CRS的结果，逗留时间,严重并发症,30天死亡率，辅助化疗的时间，和教科书的结果。患者按年度数量进行分层：低数量(9家医院，<25),中等容量(四家医院，29-37),和高容量(五家医院，54-84).描述性统计和多水平逻辑回归用于评估手术量和结果的（病例组合调整）关联。
结果：共包括1646个间期CRS（iCRS）和789个主要CRS（pCRS）。在iCRS队列中未发现手术体积与不同结果之间的关联。在pCRS队列中，高容量与完全CRS发生率增加相关(aOR1.9,95%-CI1.2-3.1,p=0.010).此外，大容量与严重并发症发生率增加(aOR2.3,1.1-4.6,95%-CI1.3-4.2,p=0.022)和住院时间延长(aOR2.3,95%-CI1.3-4.2,p=0.005)相关.30天死亡率，辅助化疗的时间，在pCRS队列中,教科书结局与手术量无关.亚组分析(FIGO-IIIC-IVB期)显示相似的结果。各种病例组合因素显著影响结果，保证病例混合调整。
结论：我们的分析不支持对晚期OC进一步集中iCRS。高容量与较高的完整pCRS相关，建议在这些医院中选择更准确的选择或采取更积极的方法。较高的完成率是以较高的严重并发症和长期入院为代价的。
方法：这项基于人群的研究包括2019年至2022年间在18家荷兰医院注册的FIGO阶段IIB-IVBOC的所有CRS。短期结果包括CRS的结果，逗留时间,严重并发症,30天死亡率，辅助化疗的时间，和教科书的结果。患者按年度数量进行分层：低数量(9家医院，<25),中等容量(四家医院，29-37),和高容量(五家医院，54-84).描述性统计和多水平逻辑回归用于评估手术量和结果的（病例组合调整）关联。
结果：共包括1646个间期CRS（iCRS）和789个主要CRS（pCRS）。在iCRS队列中未发现手术体积与不同结果之间的关联。在pCRS队列中，高容量与完全CRS发生率增加相关(aOR1.9,95%-CI1.2-3.1,p=0.010).此外，大容量与严重并发症发生率增加(aOR2.3,1.1-4.6,95%-CI1.3-4.2,p=0.022)和住院时间延长(aOR2.3,95%-CI1.3-4.2,p=0.005)相关.30天死亡率，辅助化疗的时间，在pCRS队列中,教科书结局与手术量无关.亚组分析(FIGO-IIIC-IVB期)显示相似的结果。各种病例组合因素显著影响结果，保证病例混合调整。
结论：我们的分析不支持对晚期OC进一步集中iCRS。高容量与较高的完整pCRS相关，建议在这些医院中选择更准确的选择或采取更积极的方法。较高的完成率是以较高的严重并发症和长期入院为代价的。
