• Matthew Dixon, Alyson Mahar, Lawrence Paszat, Robin McLeod, Calvin Law, Carol Swallow, Lucy Helyer, Rajini Seeveratnam, Roberta Cardoso, Tanios Bekaii-Saab, Ian Chau, Neal Church, Daniel Coit, Christopher H Crane, Craig Earle, Paul Mansfield, Norman Marcon, Thomas Miner, Sung Hoon Noh, Geoff Porter, Mitchell C Posner, Vivek Prachand, Takeshi Sano, Cornelis J H Van de Velde, Sandra Wong, and Natalie Coburn.
• Sunnybrook Research Institute, Toronto, Ontario, Canada; Department of Surgery, Maimonides Medical Center, Brooklyn, NY.
• Surgery. 2013 Nov 1; 154 (5): 1100-9.

BackgroundA relationship between higher volume providers and improved outcomes has been suggested by some studies and has been used to construct guidelines for many diseases. For gastric cancer (GC), however, optimal volume cutoffs are not clear.MethodsA multidisciplinary expert panel of 16 physicians from 6 countries scored 120 scenarios regarding provider characteristics for gastric resections for GC. Appropriateness of scenarios was scored from 1 (highly inappropriate) to 9 (highly appropriate). Median appropriateness scores from 1 to 3 were considered inappropriate, 4 to 6 uncertain, and 7 to 9 appropriate. Agreement was reached when 12 of 16 panelists scored the statement similarly. Appropriate scenarios agreed on were scored subsequently for necessity.ResultsSurgeon and hospital practice volume scenarios were evaluated. The panel felt it was inappropriate for surgeons doing ≤2 GC cases per year to perform a multivisceral resection (MVR), D2 lymphadenectomy (D2-LND), or laparoscopic total gastrectomy, and ≤6 GC cases per year for an MVR involving a pancreatoduodenectomy (MVR-PD), or endoscopic mucosal resections (EMR). It was considered appropriate for surgeons doing ≥11 GC cases per year to perform open gastrectomy or D2-LND, and ≥20 GC cases per year for any MVR, laparoscopic gastrectomy, or EMR. For hospitals, it was considered inappropriate for hospitals managing ≤4 GC cases per year to perform D2-LND or laparoscopic total gastrectomy, and ≤10 GC cases per year, for MVR-PD or EMR. Hospital volumes ≥21 cases per year was considered appropriate for any GC procedure. It was inappropriate for an MVR to be performed in a hospital without interventional radiology services and for a MVR-PD in a hospital with no level I intensive care unit.ConclusionAppropriate and inappropriate provider volumes for a variety of gastric procedures have been defined by an international expert panel.Copyright © 2013 Mosby, Inc. All rights reserved.

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