Sorbonne Université, Assistance Publique-Hôpitaux de Paris, Pitié Salpétière, Urology department, Paris, France.
Department of Obstetrical and Gynecological Sciences and Urologic Sciences, 'Sapienza' University, Rome.
Curr Opin Urol. 2018 May;28(3):251-259. doi: 10.1097/MOU.0000000000000490.
Hospital and surgical volumes, as well as complications, are considered to influence intra and postoperative results in most surgical operations. This trend is also seen in uro-oncologic surgery. The objective of this review is to critically analyze the most recent literature to give a comprehensive overview on whether surgical and hospital volumes have an impact, and whether regionalization of the procedure should be advised.
Uro-oncologic surgery has recently become more regionalized, and data coming from different population-based analyses appear to support this trend. Recent data suggest that the most beneficial procedures could be radical cystectomy, radical prostatectomy, and partial nephrectomy. For radical cystectomy, even considering different cut-off values, saw better results for postoperative complications, mortality and long-term oncological and functional outcomes in patients treated in high-volume institutions. Centralization of radical prostatectomy seems to affect short-term outcomes and costs related to prostate cancer treatment, with high-volume institutions providing more affordable treatments reducing cancer recurrence and progression. Partial nephrectomy is more frequently performed in cT1-b cancer in high-volume than low-volume institutions. Additionally, in this setting it has a higher success rate and lower complications, shorter operative time, and fewer prolonged hospital stays.
Regionalization of the procedure in high-volume centers seems to have impact on postoperative morbidity and mortality for the most frequent major uro-oncological procedures: radical prostatectomy, radical cystectomy, and partial nephrectomy; but there are insufficient data available on other procedures.
医院和手术量以及并发症被认为会影响大多数外科手术的围术期结果。这种趋势也可见于泌尿肿瘤学手术中。本综述的目的是批判性地分析最新文献，全面概述手术量和医院量是否有影响，以及是否应建议该手术的区域化。
泌尿肿瘤学手术最近已变得更加区域化，来自不同基于人群的分析的数据似乎支持这一趋势。最近的数据表明，最有益的手术可能是根治性膀胱切除术、根治性前列腺切除术和部分肾切除术。对于根治性膀胱切除术，即使考虑到不同的截止值，在高容量机构中治疗的患者的术后并发症、死亡率和长期肿瘤学及功能结果也有更好的结果。根治性前列腺切除术的集中化似乎会影响与前列腺癌治疗相关的短期结果和成本，高容量机构提供更负担得起的治疗方法，降低癌症复发和进展的风险。在高容量机构中，更多地在 cT1-b 期癌症中进行部分肾切除术，与低容量机构相比，其成功率更高，并发症更少，手术时间更短，住院时间延长更少。
在高容量中心进行该手术的区域化似乎对最常见的主要泌尿肿瘤学手术的术后发病率和死亡率有影响：根治性前列腺切除术、根治性膀胱切除术和部分肾切除术；但其他手术的可用数据不足。
