ASO Author Reflections: Challenges in Centralization and Standardization of Gastrectomy in the United States to Improve Gastric Cancer Outcomes

Excerpt

Volume–outcome relationships in technically demanding surgical oncology procedures have been well reported in the United States (US), most extensively in pancreatic and esophageal cancers. Those reports encouraged patients to seek care at high-volume centers, leading to trends of centralization and improved outcomes. However, centralization policies, either financially driven or mandatory, have never been enacted in the US and continue to be controversial.1 In this retrospective cohort study using the Texas Inpatient Database, we investigated changes over 15 years in the volume distribution of gastrectomies in Texas. Despite improvement, patient morbidity and mortality remained higher at low- and intermediate-volume centers than at high-volume centers, demonstrating that volume–outcome relationships still exist for gastrectomy. Patient and hospital differences impact this, but the volume relationship is still clear despite a slow but ongoing trend of centralization of gastrectomy for gastric cancer patients in Texas. The paper also described the challenges of centralization of gastrectomy and standardized delivery of high-quality cancer care in the US. …