Surgical oncology in the community hospital: can it be done safely?

Many studies have documented the fact that outcomes and survival are improved when major surgical oncology cases are performed at high-volume centers. Consolidation of such cases in tertiary centers, however, is often not possible or practical, due to a number of factors.

A retrospective review was performed of the operative experience of a single surgical oncologist at a community hospital in Mississippi during a noncontinuous 36-month period. Data were obtained regarding all major inpatient cancer operations, as well as complication and death rates. This review was limited to major inpatient procedures and resections performed with intent to cure.

A total of 171 major cancer cases were performed during the study period. This represented 23.7% of the total inpatient procedures performed and 47.5% of all major inpatient procedures. Distribution of surgical sites was as follows: liver-9; stomach-8; esophagus-3; pancreas-4; colon and rectum-76; breast-33; lung-13; intra-abdominal (sarcoma)-9; and thyroid-16. There were 5 complications within this group (2.9%); two of these resulted in death (1.2%).

In the hands of a single surgeon operating at a community institution, major resections for cancer and major surgical oncology cases could be done safely with acceptable complication rates and results. Whether or not such major cancer cases should be done at the community level, however, depends on a number of factors and requires further evaluation of both surgeon and hospital capabilities.