Lung cancer resection volume: is procedure volume really an indicator of quality?

The majority of lung cancer resection studies indicate that hospital and surgeon procedure volume are inversely associated with mortality. It makes intuitive sense that performing large numbers of these procedures leads to better outcomes. However, controversy exists regarding the strength and validity of this volume-outcome association. Because thresholds of procedure volume are used to recommend the regionalization of care, investigation of the volume-outcome relationship is imperative. This review will examine the methodology used in the volume-outcome relationship literature and highlight important areas of concern. Careful examination of the literature demonstrates that lung cancer resection volume is not strongly associated with mortality and should not be used as a proxy measure for quality.