Related Experiment Video
Updated: Jan 4, 2026
07:15
A Mouse Model of Incompletely Resected Soft Tissue Sarcoma for Testing Neoadjuvant Therapies
Published on: July 28, 2020
10.1K
Identifying the Minimum Volume Threshold for Retroperitoneal Soft Tissue Sarcoma Resection: Merging National Data
Anthony M Villano1, Alexander Zeymo2, Kitty S Chan2
1MedStar-Georgetown Surgical Outcomes Research Center, Washington, DC; Department of Surgery, MedStar-Georgetown University Hospital, Washington, DC.
Journal of the American College of Surgeons
|November 2, 2019
Summary
Establishing a high-volume hospital threshold for retroperitoneal soft tissue sarcoma (RPS) surgery is crucial. A minimum of 13 cases per year significantly reduces mortality risk and improves patient survival.
Area of Science:
- Oncology
- Surgical Oncology
- Health Services Research
Background:
- Retroperitoneal soft tissue sarcoma (RPS) surgery is complex, necessitating regionalization to high-volume hospitals (HVHs).
- A defined procedural volume threshold for RPS is lacking in the US, hindering effective patient referral and care regionalization.
- This study aimed to establish an HVH threshold for RPS surgery using national data and expert consensus.
Purpose of the Study:
- To determine a data-driven volume threshold for high-volume hospitals performing retroperitoneal soft tissue sarcoma surgery.
- To align statistical findings with expert opinions to establish a practical benchmark for RPS surgical care.
- To inform national and international guidelines for RPS patient referral and treatment center designation.
Main Methods:
- Analysis of 8,721 surgically treated RPS patients from the 2004-2015 National Cancer Database.
- Utilized multivariable models with linear splines to identify annual volume thresholds associated with overall and 90-day mortality.
- Surveyed 48 members of the Transatlantic Australasian Retroperitoneal Soft Tissue Sarcoma Working Group regarding optimal volume thresholds.
Main Results:
- Overall mortality risk decreased by 4% per additional case up to 13 cases/year; no further benefit was observed beyond this threshold.
- Median survival was significantly longer in hospitals performing >13 cases/year (139 months) compared to <13 cases/year (94 months).
- Following data presentation, 71.4% of experts shifted their proposed HVH threshold lower, with over 56% favoring 11-20 cases/year.
Conclusions:
- This study provides the first multicenter analysis merging data-driven volume thresholds with expert opinion for RPS surgery.
- A minimum threshold of 13 cases per year is supported by statistical analysis and expert consensus for achieving optimal patient outcomes.
- These findings will guide evidence-based hospital referral, trial design, and the development of consensus recommendations for RPS care.
