# Public risk-adjusted outcome reporting for cancer surgery to drive centralisation

Source: https://onco.cc/ideas/idea-fund-surgical-outcomes-public-reporting/  
OnCo record `idea-fund-surgical-outcomes-public-reporting` (Idea). Data CC BY-NC 4.0, attribute "Data from OnCo (onco.cc)"; commercial use needs a licence.

## TL;DR

Where you have your cancer operation strongly affects whether you survive it. Publishing each hospital's adjusted results would push complex surgery towards the centres that do it well.

## Summary

National mandatory reporting of risk-adjusted 90-day mortality, major complications, margin status, lymph node yield and volume for the most complex cancer operations (oesophagectomy, pancreatectomy, gastrectomy, cystectomy, hepatectomy, lung resection), published by hospital and, for high-volume procedures, by surgeon, with minimum volume thresholds for commissioning. The volume-outcome relationship in complex cancer surgery is among the most robust findings in health services research; the Netherlands, Denmark and parts of England have centralised and improved mortality. Public reporting plus commissioning thresholds is a policy lever that requires no new science and little money.

## Fields

- Kind: Idea
- Last checked: 2026-09-08
- Hypothesis: Mandatory public reporting with volume thresholds reduces 90-day mortality for oesophagectomy and pancreatectomy by at least a quarter within three years through centralisation and quality improvement, without reducing access measured by resection rates.
- Rationale: Dutch centralisation of oesophageal and pancreatic surgery reduced mortality substantially; the Netherlands' DICA audit and Sweden's registries show public, audited outcomes drive improvement. Many systems still permit very low-volume complex cancer surgery.
- Proposed test: Introduce reporting and thresholds in one country and compare mortality, complication and resection rates with the preceding period and with a country without reporting.
- Maturity: being-tested-at-scale
- Actor: policy

## Sources

- ACS NSQIP: https://www.facs.org/quality-programs/data-and-registries/acs-nsqip/

## Connected records

- ideas: [A video-based surgical quality registry linking assessed skill to cancer outcomes](https://onco.cc/ideas/idea-fund-surgical-video-registry/), [Mandatory staged registries for new surgical techniques before wide adoption](https://onco.cc/ideas/idea-fund-device-technique-registry/)
- cancers: [Bladder & urothelial cancer](https://onco.cc/cancers/urothelial/), [Gastric & gastro-oesophageal junction cancer](https://onco.cc/cancers/gastric/), [Oesophageal cancer](https://onco.cc/cancers/esophageal/), [Pancreatic ductal adenocarcinoma](https://onco.cc/cancers/pancreatic/)
- institutions: [Netherlands Cancer Institute (NKI-AvL)](https://onco.cc/institutions/nki/)
- bottlenecks: [Fragmented care and guideline gaps](https://onco.cc/bottlenecks/b-care-fragmentation/), [Surgery and radiotherapy cure most, get least](https://onco.cc/bottlenecks/b-surgery-radiation-innovation/)

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