Cancer care in the pediatric surgical patient: A paradigm to abolish volume-outcome disparities in surgery

Background. The objective of this study was to define the prognostic significance of hospital surgical volume on outcomes for pediatric neuroblastoma and Wilms tumor Methods. The Florida Cancer Data System was examined for all pediatric patients treated between 1981 and 2004. Results. Of the 869 patients with neuroblastoma identified, 463 were treated at 5 high-volume centers (HVC) and 406 were treated at 61 low-volume centers (LVC). There were no differences in sex, age at diagnosis, race, ethnicity, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (70.6% and 67.7% at HVC vs 69.3% and 65.2% at LVC, P = .243). Multivariate analysis identified age at diagnosis and tumor stage as independent prognostic factors. Of the 790 patients with Wilms tumor identified, 395 were treated at 5 HVC and 395 were treated at 50 LVC. There were no differences in sex, age of diagnosis, or stage of disease between the 2 groups. The 5- and 10-year survival rates were identical between treatment groups (91.3% and 89.9% at HVC vs 89.7% and 88.5% at LVC, P = .698). Multivariate analysis identified ethnicity, tumor stage, and use of chemotherapy as independent prognostic factors. Conclusion. Survival rates for patients with neuroblastoma and Wilms tumor are unrelated to the hospital surgical volume or patient race. This result stands in stark contrast to a variety of adult malignancies. Models used for pediatric patient care for cancer may provide insight into ways to improve the treatment of adult patients in need of complex cancer care. (Surgery 2009;145:76-85.)