Elsevier

HPB

Volume 18, Issue 4, April 2016, Pages 317-324
HPB

Original article
Volume–outcome relationships in pancreatoduodenectomy for cancer

https://doi.org/10.1016/j.hpb.2016.01.515Get rights and content
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Abstract

Background

Volume–outcome relationships in pancreatic surgery are well established, but an optimal volume remains to be determined. Studies analyzing outcomes in volume categories exceeding 20 procedures annually are lacking.

Study design

A consecutive 3420 patients underwent PD for primary pancreatic or periampullary carcinoma (2005–2013) and were registered in the Netherlands Cancer Registry. Relationships between hospital volume (<5, 5–19, 20–39 and ≥40 PDs/year) and mortality and survival were explored.

Results

There was a non-significant decrease in 90-day mortality from 8.1 to 6.7% during the study period (p = 0.23). Ninety-day mortality was 9.7% in centers performing <5 PDs/year (n = 185 patients), 8.9% for 5–19 PDs/year (n = 1432), 7.3% for 20–39 PDs/year (n = 240) and 4.3% for ≥40 PDs/year (n = 562, p = 0.004). Within volume categories, 90-day mortality did not change over time. After adjustment for confounding factors, significantly lower mortality was found in the ≥40 category compared to 20–39 PDs/year (OR = 1.72 (1.08–2.74)). Overall survival adjusted for confounding factors was better in the ≥40 category compared to categories under 20 PDs/year: HR (≥40 vs 5–19/year) = 1.24 (1.09–1.42). In the ≥40 category significantly more patients received adjuvant chemotherapy and had >10 lymph nodes retrieved compared to lower volume categories.

Conclusions

Volume–outcome relationships in pancreatic surgery persist in centers performing ≥40 PDs annually, regarding both mortality and survival. The volume plateau for pancreatic surgery has yet to be determined.

Cited by (0)

This paper was presented at the European-African Hepato-Pancreato-Biliary Association meeting in Manchester, UK, April 2015, the European Pancreatic Club meeting in Toledo, Spain, June 2015 and at the World Pancreas Forum in Bern, Switzerland, June 2015 (Best Poster Award).

Lydia G.M. van der Geest and L. Bengt van Rijssen contributed equally to this work.

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Valery E.P.P. Lemmens and Marc G.H. Besselink shared senior authorship.