Volume-outcome associations in head and neck cancer treatment: a systematic review and meta-analysis

Head Neck. 2014 Dec;36(12):1820-34. doi: 10.1002/hed.23498. Epub 2014 Feb 4.


Background: Because of the relative rarity of head and neck malignancies and their complex treatment, some groups have advocated for regionalized care. Studies comparing high- and low-volume centers have demonstrated mixed results.

Methods: We conducted a systematic review using MEDLINE and EMBASE including all studies examining a volume-outcome relationship in the treatment of patients with head and neck cancer with meta-analysis for long-term survival results.

Results: Seventeen studies were identified. Meta-analysis was performed for studies that assessed long-term survival. High-volume hospitals (5 studies; hazard ratio [HR], 0.886; 95% confidence interval [CI], 0.820-0.956) and high-volume surgeons (2 studies; HR, 0.767; 95% CI, 0.641-0.919) have better overall survival than low-volume hospitals and surgeons, respectively.

Conclusion: Volume-outcome associations exist for head and neck oncologic procedures, although this has not been fully investigated for salivary gland malignancies. Future quality of care studies in head and neck oncology should focus on processes of care, which may explain this relationship.

Keywords: free flap reconstruction; head and neck cancer; health services research; hospital volume; meta-analysis; neck dissection; surgeon volume; systematic review.

Publication types

  • Meta-Analysis
  • Research Support, Non-U.S. Gov't
  • Review
  • Systematic Review

MeSH terms

  • Head and Neck Neoplasms / mortality
  • Head and Neck Neoplasms / surgery*
  • Hospitals, High-Volume*
  • Hospitals, Low-Volume*
  • Humans
  • Outcome Assessment, Health Care