RT Journal
A1 Schwarz RE, Ellenhorn JI
T1 INfluence of hospital volume on mortality following major cancer surgery
JF JAMA
JO JAMA
YR 1999
FD April 21
VO 281
IS 15
SP 1374
OP 1374
DO 10.1001/jama.281.15.1374
UL http://dx.doi.org/10.1001/jama.281.15.1374
AB 
While a high-volume center is more likely to achieve better outcome,
excellent outcome is still feasible in low-volume centers under certain
circumstances. For instance, Begg et al list zero mortality after
pancreatectomy in 5 hospitals with only 5 patients each during the
study interval of 10 years. At the City of Hope National Medical
Center, a "low-volume" institution according to a definition
offered by Lieberman et al,2 54 patients have undergone
partial or total pancreatectomy between 1988 and 1998, including 50 for
a diagnosis of cancer. Nine surgeons performed a median of 6 such
procedures during this time period (range, 2-8). All surgical
oncologists were fellowship- or specialty-trained, most in high-volume
cancer centers. Thirty-day or in-hospital mortality was zero. The
median length of stay (LOS) was 16.5 days (12 days since 1994). The
median postoperative survival, depending on cancer site, ranged from
22.5 months (pancreatic) to 56 months (ampullary and bile duct).