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Understanding the Importance of High-Volume Surgeons for Treating Rare Urologic Cancers

Jan. 28, 2021

Upper tract urothelial cell carcinoma is a rare cancer affecting the organs of the reproductive system and the urinary system, making up 5% to 10% of these types of cancers. For this high-risk cancer, the best available treatment is removal of the kidney and ureter (a tube that carries urine from the kidney to bladder) in a surgery known as a nephroureterectomy. This surgery has a notable learning curve, and patients may have worse outcomes when this operation is performed by inexperienced surgeons.

Aaron Laviana, M.D., MBA, and his team of research colleagues from Vanderbilt University studied the relationship between treatment at a high-volume hospital and outcomes from this operation. Published in this month’s issue of the journal Urology, his research team, led by Wilson Sui, M.D., analyzed the National Cancer Database and identified over 37,000 nephroureterectomies performed across 1,290 U.S. hospitals.

Interestingly, they found that over 70% of the hospitals performing this operation perform less than three of these operations per year. High-volume centers (hospitals doing six or more operations per year) were more likely to have a robust research and academic presence. Importantly, patients treated at high-volume centers were found to have shorter length of stays, fewer readmissions, fewer positive margins (cancer cells remaining after surgery) and lower rates of death. They also found a consistent dose response relationship with increasing volume associated with improved perioperative outcomes.

Patients with UTUC require not only surgical but also great medical management for long-term success. High surgical volume not only contributes to surgeons’ technical expertise, but there are also likely other important factors at play such as better access to clinical trials, improved infrastructure and increased use of multidisciplinary care models.

These findings suggest significant potential benefits to the centralization of performing nephroureterectomies. Thus, it may be important that these patients are referred to centers that have vast experience with treating this disease such as at Dell Medical School, where Laviana has years of experience treating this disease using minimally invasive robotic techniques.

In a similar study, his research team is now exploring the association between surgical volume and survival among patients with variant histologies of bladder cancer, some of the rarest yet most aggressive types of this disease. There has been a growing push for centralizing the treatment of advanced bladder cancer to high-volume surgeons and hospitals given the positive effects centralized treatment has on outcomes.

Laviana’s team is exploring how treatment at high-volume centers affects patients with variant histology bladder cancer. They continue to investigate ways to improve long-term survival for these patients. Importantly, Laviana has established Dell Medical School as a leader in treating these complex disease processes.