Objective: The center of excellence model of health care hypothesizes that increased volume in a specialized center will lead to better and more affordable care. We sought to characterize the volume-outcome data for surgically treated sinonasal and skull base tumors and (chemo) radiation-treated nasopharyngeal malignancy. Design: Systematic review of the literature. Setting: This review included national database and multi-institutional studies published between 1990 and 2019. Participants: PubMed was interrogated for keywords “hospital volume,” “facility volume,” and outcomes for “Nasopharyngeal carcinoma,” “Sinonasal carcinomas,” “Pituitary Tumors,” “Acoustic Neuromas,” “Chordomas,” and “Skull Base Tumors” to identify studies. Single-institution studies and self-reported surveys were excluded. Main outcome measures: The main outcome of interest in malignant pathologies was survival; and in benign pathologies it was treatment-related complications. Results: A total of 20 studies met inclusion criteria. The average number of patients per study was 4,052, and ranged from 394 to 9,950 patients. Six of seven studies on malignant pathology demonstrated improved survival with treatment in high volume centers and one showed no association with survival. Ten of thirteen studies on benign disease showed reduced risk of complications, while one study demonstrated both an increased and decreased association of complications. Two studies showed no volume-outcome associations. Conclusion: This systematic review demonstrates that a positive volume–outcome relationship exists for most pathologies of the skull base, with some exceptions. The relative dearth of literature supports further research to understand the effect of centralization of care on treatment outcomes. Podium presentation at the National American Skull Base Surgery (NASBS) Annual Meeting on February 7^th, 2020 in San Antonio, TX. ^* Stephanie Flukes and Rahul K. Sharma are co-first authors Received: 02 March 2020 Accepted: 25 September 2020 Publication Date: 19 January 2021 (online) © 2021. Thieme. All rights reserved. Georg Thieme Verlag KG Rüdigerstraße 14, 70469 Stuttgart, Germany

Introduction: Elderly patients (≥80 years of age) with head and neck cancer (HNC) can prove a management challenge due to concerns regarding their suitability for surgery. This study aims to describe the characteristics and outcomes of elderly patients undergoing HNC surgery.Methods: A retrospective review of elderly patients undergoing HNC surgery was conducted. Demographics, comorbidities, tumor characteristics, surgical procedure type, postoperative complications, and disposition were reviewed. Overall survival (OS) in the elderly cohort was compared against younger patients (80 years (71% male; mean age 84.8, range 80.0–98.8 years). The overall complication rate was 43%. When compared with younger patients (n = 509), elderly patients had reduced OS (risk ratio: 2.0, 95% CI: 1.3–3.2), higher 90‐day mortality (8.1% vs. 2.3%, p = .005), and lower 5‐year survival (43.5% vs. 64.1%, p < .001). However, survival was comparable to age‐specific life expectancy. There was no difference in OS, 90‐day mortality, and 5‐year survival when comparing >85 (n = 33) and 80–85 (n = 53) age groups.Conclusions: Chronological age alone should not negatively influence decision‐making in HNC surgery the elderly. With careful preoperative selection and optimization, surgery can be performed at acceptable risk with good outcomes in elderly patients.Level of evidence: IV