Relationship between the volume of robotic-assisted surgery performed and the outcomes achieved

Review of recently published evidence on the relationship between the volume of robotic-assisted surgery (RAS) performed and the outcomes achieved
Scottish Health Technology Group, Healthcare Improvement Scotland 10 February 2021

• An evidence summary on the impact of the number of robotic-assisted procedures (gynaecological, colorectal, urological) per treatment centre/surgeon on the outcomes achieved, and related evidence on the learning curves for these procedures. 
• Only a small number of studies were identified, most of them with methodological issues affecting their validity. Definitions of high and low volumes differ across studies and make comparisons between studies and indications difficult.

Key findings

Chemotherapy and radiotherapy for advanced pancreatic cancer

Chemotherapy and radiotherapy for advanced pancreatic cancer
Cochrane Database of Systematic Reviews 20 March 2018, Issue 3. Art. No.: CD011044

• The review identified studies (n=42) in people with pancreatic cancer that could not be operated on (locally advanced) or that had already spread beyond the pancreas (metastatic). The studies involved 9463 participants who were receiving their first therapy for pancreatic cancer.
• This review has shown that in advanced disease, combination chemotherapy with FOLFIRINOX (5-fluorouracil, irinotecan, oxaliplatin combination); GEMOXEL (gemcitabine, oxaliplatin and capecitabine); cisplatin/epirubicin/5FU/gemcitabine; gemcitabine plus nab-paclitaxel; and gemcitabine plus a fluoropyrimidine agent, provide a survival advantage over gemcitabine alone. These combinations do increase side effects. Gemcitabine given slowly using a fixed rate of infusion may be more effective than giving it in the standard way, which is quickly over 30 minutes.

Impact of Trauma System Structure on Injury Outcomes:

Impact of Trauma System Structure on Injury Outcomes: A Systematic Review and Meta-Analysis.
World J Surg. 2017 Oct 25. doi: 10.1007/s00268-017-4292-0.
Abstract: https://www.ncbi.nlm.nih.gov/pubmed/29071424

• A systematic review of evidence around components which contribute to the effectiveness of trauma systems. 
•  Two studies recommended trauma system components were associated with reduced odds of mortality: inclusive design (odds ratio [OR] = 0.72 [0.65-0.80]) and helicopter transport (OR = 0.70 [0.55-0.88]). 
• Pre-Hospital Advanced Trauma Life Support was associated with a significant reduction in hospital days (mean difference [MD] = 5.7 [4.4-7.0]) but a nonsignificant reduction in mortality (OR = 0.78 [0.44-1.39]). 
• Population density of surgeons was associated with a nonsignificant decrease in mortality (MD = 0.58 [-0.22 to 1.39]). 
• Trauma system maturity was associated with a significant reduction in mortality (OR = 0.76 [0.68-0.85]). 
• Quality of evidence was low or very low for mortality and healthcare utilization. 

Specialised services: Rapid summary of policy and guidance

Specialised services: Rapid summary of policy and guidance
Midland and Lancs CSU, March 2016

• A digest of key policy and guidance recommendations relevant to health and social care within England, to inform Sustainability and Transformation Planning (STP). 
• The digest is based on a rapid search for documentation from notable organisations involved in developing policy and guidance relevant to specialised services.