Department of Surgery, Section of Endocrine Surgery, Duke University Medical Center, Durham, NC, USA.
Department of Surgery, University of California at San Francisco (UCSF), San Francisco, CA, USA.
Best Pract Res Clin Endocrinol Metab. 2019 Oct;33(5):101296. doi: 10.1016/j.beem.2019.101296. Epub 2019 Jul 12.
The relationship between operative volume and perioperative outcomes after several oncologic operations is well documented. Recent studies on adrenalectomy reveal a robust association between higher surgeon volume and improved patient outcomes. Statistical analyses have demonstrated that outcomes are improved when surgeons perform at least six adrenalectomies annually; based on this threshold definition of a 'high-volume' surgeon, more than 80% of adrenalectomies in the United States are performed by 'low-volume' surgeons. When compared to low-volume surgeons, high-volume surgeons on average achieve lower rates of postoperative complications and mortality, as well as a shorter length of hospital stay, and lower cost of hospitalization. There does not appear to be a similar association between hospital adrenalectomy volume and improved patient outcomes; however, there is evidence of benefit for the subset of patients with adrenocortical carcinoma. Despite limitations of existing literature, evidence is sufficient to recommend the referral of patients with adrenal tumors to high-volume surgeons.
多项肿瘤手术的手术量与围手术期结果之间的关系已有充分的文献记载。最近关于肾上腺切除术的研究表明，外科医生的手术量与患者预后的改善之间存在很强的关联。统计分析表明，当外科医生每年至少进行 6 例肾上腺切除术时，手术效果会得到改善；根据“高容量”外科医生的这一门槛定义，美国超过 80%的肾上腺切除术是由“低容量”外科医生完成的。与低容量外科医生相比，高容量外科医生的术后并发症和死亡率以及住院时间和住院费用均较低。医院肾上腺切除术量与改善患者预后之间似乎没有类似的关联；但是，有证据表明，对于肾上腺皮质癌亚组的患者有获益。尽管现有文献存在局限性，但有足够的证据推荐将有肾上腺肿瘤的患者转介给高容量外科医生。
