Skip to main content
Erschienen in: Annals of Surgical Oncology 6/2016

21.01.2016 | Pancreatic Tumors

Elderly Patients Strongly Benefit from Centralization of Pancreatic Cancer Surgery: A Population-Based Study

verfasst von: Lydia G. M. van der Geest, Marc G. H. Besselink, MD, PhD, Olivier R. C. Busch, MD, PhD, Ignace H. J. T. de Hingh, MD, PhD, Casper H. J. van Eijck, MD, PhD, Cees H. C. Dejong, MD, PhD, Valery E. P. P. Lemmens, PhD

Erschienen in: Annals of Surgical Oncology | Ausgabe 6/2016

Einloggen, um Zugang zu erhalten

Abstract

Background

Series from expert centers suggest that pancreas cancer surgery is safe for elderly patients but nationwide data, taking hospital volume into account, are lacking.

Methods

From the Netherlands Cancer Registry, all 3420 patients who underwent pancreatoduodenectomy (PD) for primary pancreatic or periampullary carcinoma in 2005–2013 were selected. Associations between age (<75, ≥75 years), hospital volume (tertiles), and postoperative mortality (30, 90 day) were evaluated by χ 2 tests and logistic regression analyses. Overall survival was investigated by means of Kaplan–Meier and Cox proportional hazard regression analyses.

Results

The proportion of elderly patients (≥75 years) undergoing PD increased from 15 % in 2005–2007 to 20 % in 2011–2013 (p = 0.009). In low (<15 per year), medium (15–28 per year), and high (>28 per year) hospital volume tertiles, the proportion of elderly patients was 16, 20, and 17 %, respectively (p = 0.10). With increasing hospital volume, 30-day postoperative mortality was 6.0–4.5–2.9 % (p = 0.002) and 90-day mortality 9.3–8.0–5.3 % (p = 0.001), respectively. Within each volume tertile, adjusted 30- and 90-day mortality of elderly patients was 1.6–2.5 times higher compared to outcomes of younger patients. Adjusted 30-day mortality in elderly patients was higher in low-volume hospitals (odds ratio = 2.87, 95 % confidence interval 1.15–7.17) compared to high-volume hospitals. Similarly, elderly patients had a worse overall survival in low-volume hospitals (hazard ratio = 1.28, 95 % confidence interval 1.01–1.63). Postoperative mortality of elderly patients in high-volume hospitals was similar to mortality of younger patients in low- and medium-volume hospitals.

Conclusions

Elderly patients benefit from centralization by undergoing PD in high-volume hospitals, both with respect to postoperative mortality and survival. It would seem reasonable to place elderly patients into a high-risk category; they should only undergo surgery in the highest-tertile-volume hospitals.
Anhänge
Nur mit Berechtigung zugänglich
Literatur
2.
Zurück zum Zitat Abraham A, Al-Refaie WB, Parsons HM, Dudeja V, Vickers SM, Habermann EB. Disparities in pancreas cancer care. Ann Surg Oncol. 2013;20:2078–87.CrossRefPubMed Abraham A, Al-Refaie WB, Parsons HM, Dudeja V, Vickers SM, Habermann EB. Disparities in pancreas cancer care. Ann Surg Oncol. 2013;20:2078–87.CrossRefPubMed
3.
Zurück zum Zitat Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th edition AJCC pancreatic cancer staging system: report from the National Cancer Data Base. Cancer. 2007;110:738–44.CrossRefPubMed Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6th edition AJCC pancreatic cancer staging system: report from the National Cancer Data Base. Cancer. 2007;110:738–44.CrossRefPubMed
4.
Zurück zum Zitat Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.CrossRefPubMed Birkmeyer JD, Siewers AE, Finlayson EV, et al. Hospital volume and surgical mortality in the United States. N Engl J Med. 2002;346:1128–37.CrossRefPubMed
5.
Zurück zum Zitat Gooiker GA, van Gijn W, Wouters MW, et al. Systematic review and meta-analysis of the volume–outcome relationship in pancreatic surgery. Br J Surg. 2011;98:485–94.CrossRefPubMed Gooiker GA, van Gijn W, Wouters MW, et al. Systematic review and meta-analysis of the volume–outcome relationship in pancreatic surgery. Br J Surg. 2011;98:485–94.CrossRefPubMed
6.
Zurück zum Zitat van Heek NT, Kuhlmann KF, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–8.CrossRefPubMedPubMedCentral van Heek NT, Kuhlmann KF, Scholten RJ, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–8.CrossRefPubMedPubMedCentral
7.
Zurück zum Zitat Birkmeyer JD, Dimick JB. Understanding and reducing variation in surgical mortality. Annu Rev Med. 2009;60:405–15.CrossRefPubMed Birkmeyer JD, Dimick JB. Understanding and reducing variation in surgical mortality. Annu Rev Med. 2009;60:405–15.CrossRefPubMed
8.
Zurück zum Zitat Gooiker GA, van der Geest LG, Wouters MW, et al. Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol. 2011;18:1821–9.CrossRefPubMedPubMedCentral Gooiker GA, van der Geest LG, Wouters MW, et al. Quality improvement of pancreatic surgery by centralization in the western part of the Netherlands. Ann Surg Oncol. 2011;18:1821–9.CrossRefPubMedPubMedCentral
9.
Zurück zum Zitat Lemmens VE, Bosscha K, van der Schelling G, Brenninkmeijer S, Coebergh JW, de Hingh IH. Improving outcome for patients with pancreatic cancer through centralization. Br J Surg. 2011;98:1455–62.CrossRefPubMed Lemmens VE, Bosscha K, van der Schelling G, Brenninkmeijer S, Coebergh JW, de Hingh IH. Improving outcome for patients with pancreatic cancer through centralization. Br J Surg. 2011;98:1455–62.CrossRefPubMed
10.
Zurück zum Zitat de Wilde RF, Besselink MG, van der Tweel I, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–10.CrossRefPubMed de Wilde RF, Besselink MG, van der Tweel I, et al. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012;99:404–10.CrossRefPubMed
11.
Zurück zum Zitat Riall TS, Sheffield KM, Kuo YF, Townsend CM Jr, Goodwin JS. Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. J Am Geriatr Soc. 2011;59:647–54.CrossRefPubMedPubMedCentral Riall TS, Sheffield KM, Kuo YF, Townsend CM Jr, Goodwin JS. Resection benefits older adults with locoregional pancreatic cancer despite greater short-term morbidity and mortality. J Am Geriatr Soc. 2011;59:647–54.CrossRefPubMedPubMedCentral
12.
Zurück zum Zitat van Gestel YR, Lemmens VE, de Hingh IH, et al. Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol. 2013;20:371–80.CrossRefPubMed van Gestel YR, Lemmens VE, de Hingh IH, et al. Influence of comorbidity and age on 1-, 2-, and 3-month postoperative mortality rates in gastrointestinal cancer patients. Ann Surg Oncol. 2013;20:371–80.CrossRefPubMed
13.
Zurück zum Zitat Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford). 2012;14:649–57.CrossRefPubMed Sukharamwala P, Thoens J, Szuchmacher M, Smith J, DeVito P. Advanced age is a risk factor for post-operative complications and mortality after a pancreaticoduodenectomy: a meta-analysis and systematic review. HPB (Oxford). 2012;14:649–57.CrossRefPubMed
14.
Zurück zum Zitat Swanson RS, Pezzi CM, Mallin K, Loomis AM, Winchester DP. The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the National Cancer Data Base. Ann Surg Oncol. 2014, 21(3):4059–67.CrossRefPubMed Swanson RS, Pezzi CM, Mallin K, Loomis AM, Winchester DP. The 90-day mortality after pancreatectomy for cancer is double the 30-day mortality: more than 20,000 resections from the National Cancer Data Base. Ann Surg Oncol. 2014, 21(3):4059–67.CrossRefPubMed
15.
Zurück zum Zitat Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology (ICD-O). 3rd ed. Geneva: World Health Organization; 2000. Fritz A, Percy C, Jack A, et al. International classification of diseases for oncology (ICD-O). 3rd ed. Geneva: World Health Organization; 2000.
16.
Zurück zum Zitat Wittekind C, Greene FL, Hutter RVP, Klimpfinger M, Sobin LH. TNM atlas. Berlin: Springer-Verlag; 2004. Wittekind C, Greene FL, Hutter RVP, Klimpfinger M, Sobin LH. TNM atlas. Berlin: Springer-Verlag; 2004.
17.
Zurück zum Zitat Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JW, Janssen-Heijnen ML. A 50 % higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br J Cancer. 2010;103:1742–8.CrossRefPubMedPubMedCentral Louwman WJ, Aarts MJ, Houterman S, van Lenthe FJ, Coebergh JW, Janssen-Heijnen ML. A 50 % higher prevalence of life-shortening chronic conditions among cancer patients with low socioeconomic status. Br J Cancer. 2010;103:1742–8.CrossRefPubMedPubMedCentral
18.
Zurück zum Zitat Reames BN, Birkmeyer NJ, Dimick JB, Ghaferi AA. Socioeconomic disparities in mortality after cancer surgery: failure to rescue. JAMA Surg. 2014;149:475–81.CrossRefPubMedPubMedCentral Reames BN, Birkmeyer NJ, Dimick JB, Ghaferi AA. Socioeconomic disparities in mortality after cancer surgery: failure to rescue. JAMA Surg. 2014;149:475–81.CrossRefPubMedPubMedCentral
19.
Zurück zum Zitat Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014;101:1000–5.CrossRefPubMed Gooiker GA, Lemmens VE, Besselink MG, et al. Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014;101:1000–5.CrossRefPubMed
20.
22.
Zurück zum Zitat Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp KG. Physician, patient, and contextual factors affecting treatment decisions in older adults with cancer and models of decision making: a literature review. Oncol Nurs Forum. 2012;39:E70–83.CrossRefPubMedPubMedCentral Tariman JD, Berry DL, Cochrane B, Doorenbos A, Schepp KG. Physician, patient, and contextual factors affecting treatment decisions in older adults with cancer and models of decision making: a literature review. Oncol Nurs Forum. 2012;39:E70–83.CrossRefPubMedPubMedCentral
23.
Zurück zum Zitat Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol. 2009;27:4671–8.CrossRefPubMedPubMedCentral Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol. 2009;27:4671–8.CrossRefPubMedPubMedCentral
24.
Zurück zum Zitat Mayo SC, Gilson MM, Herman JM, et al. Management of patients with pancreatic adenocarcinoma: national trends in patient selection, operative management, and use of adjuvant therapy. J Am Coll Surg. 2012;214:33–45.CrossRefPubMedPubMedCentral Mayo SC, Gilson MM, Herman JM, et al. Management of patients with pancreatic adenocarcinoma: national trends in patient selection, operative management, and use of adjuvant therapy. J Am Coll Surg. 2012;214:33–45.CrossRefPubMedPubMedCentral
25.
Zurück zum Zitat Belyaev O, Herzog T, Kaya G, et al. Pancreatic surgery in the very old: face to face with a challenge of the near future. World J Surg. 2013;37:1013–20.CrossRefPubMed Belyaev O, Herzog T, Kaya G, et al. Pancreatic surgery in the very old: face to face with a challenge of the near future. World J Surg. 2013;37:1013–20.CrossRefPubMed
26.
Zurück zum Zitat Turrini O, Paye F, Bachellier P, et al. Pancreatectomy for adenocarcinoma in elderly patients: postoperative outcomes and long term results: a study of the French Surgical Association. Eur J Surg Oncol. 2013;39:171–8.CrossRefPubMed Turrini O, Paye F, Bachellier P, et al. Pancreatectomy for adenocarcinoma in elderly patients: postoperative outcomes and long term results: a study of the French Surgical Association. Eur J Surg Oncol. 2013;39:171–8.CrossRefPubMed
27.
Zurück zum Zitat Lee DY, Schwartz JA, Wexelman B, Kirchoff D, Yang KC, Attiyeh F. Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg. 2014;207:540–8.CrossRefPubMed Lee DY, Schwartz JA, Wexelman B, Kirchoff D, Yang KC, Attiyeh F. Outcomes of pancreaticoduodenectomy for pancreatic malignancy in octogenarians: an American College of Surgeons National Surgical Quality Improvement Program analysis. Am J Surg. 2014;207:540–8.CrossRefPubMed
28.
Zurück zum Zitat Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.CrossRefPubMed Oettle H, Neuhaus P, Hochhaus A, et al. Adjuvant chemotherapy with gemcitabine and long-term outcomes among patients with resected pancreatic cancer: the CONKO-001 randomized trial. JAMA. 2013;310:1473–81.CrossRefPubMed
29.
Zurück zum Zitat Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010;304:1073–81.CrossRefPubMed Neoptolemos JP, Stocken DD, Bassi C, et al. Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA. 2010;304:1073–81.CrossRefPubMed
30.
Zurück zum Zitat Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22:3099–103.CrossRefPubMed Read WL, Tierney RM, Page NC, et al. Differential prognostic impact of comorbidity. J Clin Oncol. 2004;22:3099–103.CrossRefPubMed
Metadaten
Titel
Elderly Patients Strongly Benefit from Centralization of Pancreatic Cancer Surgery: A Population-Based Study
verfasst von
Lydia G. M. van der Geest
Marc G. H. Besselink, MD, PhD
Olivier R. C. Busch, MD, PhD
Ignace H. J. T. de Hingh, MD, PhD
Casper H. J. van Eijck, MD, PhD
Cees H. C. Dejong, MD, PhD
Valery E. P. P. Lemmens, PhD
Publikationsdatum
21.01.2016
Verlag
Springer International Publishing
Erschienen in
Annals of Surgical Oncology / Ausgabe 6/2016
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5089-3

Weitere Artikel der Ausgabe 6/2016

Annals of Surgical Oncology 6/2016 Zur Ausgabe

Healthcare Policy and Outcomes

Global Curriculum in Surgical Oncology

Update Chirurgie

Bestellen Sie unseren Fach-Newsletter und bleiben Sie gut informiert.

S3-Leitlinie „Diagnostik und Therapie des Karpaltunnelsyndroms“

CME: 2 Punkte

Prof. Dr. med. Gregor Antoniadis Das Karpaltunnelsyndrom ist die häufigste Kompressionsneuropathie peripherer Nerven. Obwohl die Anamnese mit dem nächtlichen Einschlafen der Hand (Brachialgia parästhetica nocturna) sehr typisch ist, ist eine klinisch-neurologische Untersuchung und Elektroneurografie in manchen Fällen auch eine Neurosonografie erforderlich. Im Anfangsstadium sind konservative Maßnahmen (Handgelenksschiene, Ergotherapie) empfehlenswert. Bei nicht Ansprechen der konservativen Therapie oder Auftreten von neurologischen Ausfällen ist eine Dekompression des N. medianus am Karpaltunnel indiziert.

Prof. Dr. med. Gregor Antoniadis
Berufsverband der Deutschen Chirurgie e.V.

S2e-Leitlinie „Distale Radiusfraktur“

CME: 2 Punkte

Dr. med. Benjamin Meyknecht, PD Dr. med. Oliver Pieske Das Webinar S2e-Leitlinie „Distale Radiusfraktur“ beschäftigt sich mit Fragen und Antworten zu Diagnostik und Klassifikation sowie Möglichkeiten des Ausschlusses von Zusatzverletzungen. Die Referenten erläutern, welche Frakturen konservativ behandelt werden können und wie. Das Webinar beantwortet die Frage nach aktuellen operativen Therapiekonzepten: Welcher Zugang, welches Osteosynthesematerial? Auf was muss bei der Nachbehandlung der distalen Radiusfraktur geachtet werden?

PD Dr. med. Oliver Pieske
Dr. med. Benjamin Meyknecht
Berufsverband der Deutschen Chirurgie e.V.

S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“

CME: 2 Punkte

Dr. med. Mihailo Andric
Inhalte des Webinars zur S1-Leitlinie „Empfehlungen zur Therapie der akuten Appendizitis bei Erwachsenen“ sind die Darstellung des Projektes und des Erstellungswegs zur S1-Leitlinie, die Erläuterung der klinischen Relevanz der Klassifikation EAES 2015, die wissenschaftliche Begründung der wichtigsten Empfehlungen und die Darstellung stadiengerechter Therapieoptionen.

Dr. med. Mihailo Andric
Berufsverband der Deutschen Chirurgie e.V.