Centralization of Pancreatic Surgery Improves Results: Review

Abstract

Background and Aims: The effect of operation volume on the outcomes of pancreatic surgery has been a subject of research since the 1990s. In several countries around the world, this has led to the centralization of pancreatic surgery. However, controversy persists as to the benefits of centralization and what the optimal operation volume for pancreatic surgery actually is. This review summarizes the data on the effect of centralization on mortality, complications, hospital facilities used, and costs regarding pancreatic surgery. Materials and Methods: A systematic librarian-assisted search was performed in PubMed covering the years from August 1999 to August 2019. All studies comparing results of open pancreatic resections from high- and low-volume centers were included. In total 44, published articles were analyzed. Results: Studies used a variety of different criteria for high-volume and low-volume centers, which hampers the evaluating of the effect of operation volume. However, mortality in high-volume centers is consistently reported to be lower than in low-volume centers. In addition, failure to rescue critically ill patients is more common in low-volume centers. Cost-effectiveness has also been evaluated in the literature. Length of hospital stay in particular has been reported to be shorter in high-volume centers than in low-volume centers. Conclusion: The effect of centralization on the outcomes of pancreatic surgery has been under active research and the beneficial effect of it is associated especially with better short-term prognosis after surgery.

Using Textbook Outcomes to benchmark practice in pancreatic surgery

“…Therefore, most HPB centres within NZ do not meet the definition of high-volume centres. 9,10 The results of this study show that the rate of TO for pancreatic surgery at Christchurch Hospital are comparable to those from the nationwide Dutch outcomes, both within the individual items of TO and overall. This study has shown TO to be a useful tool to benchmark a medium volume centre in an isolated location against an external national dataset of pancreatic surgery outcomes.…”

“…Unlike the UK or the Netherlands, New Zealand (NZ) has not adopted a centralized population‐based service provision model for cancer care. Therefore, most HPB centres within NZ do not meet the definition of high‐volume centres 9,10 . The results of this study show that the rate of TO for pancreatic surgery at Christchurch Hospital are comparable to those from the nationwide Dutch outcomes, both within the individual items of TO and overall.…”

Reshaping preoperative treatment of pancreatic cancer in the era of precision medicine

“…Health systems face an overall lack of bioinformatics capacity specialised in the analysis and interpretation of complex data obtained from tumour sequencing. Furthermore, despite evidence of better outcomes for PC patients managed in high-volume centres, 95,96 the vast majority are still diagnosed and treated at community hospitals where access to molecular analysis is limited and practising oncologists have little or no training to successfully use the information for clinical decision making. 89 Conversely, the centralisation of current clinical implementation of multiomics technologies in highly specialised tertiary cancer centres poses important considerations about disparities of access to cutting-edge cancer programs.…”

Realistic Advantages of Early Surgical Drain Removal after Pancreatoduodenectomy: A Single-institution Retrospective Study

“…Pancreatoduodenectomy (PD) is a major surgical procedure, mostly performed to remove periampullary tumors arising from the head of the pancreas, distal bile duct, duodenum, or ampulla of Vater. The procedure is associated with perioperative mortality rates up to 2%, and overall complication rates of 40 to 50%, even at high-volume centers 1,2 . One of the most disturbing complications is postoperative pancreatic stulas (POPFs) and particularly, clinically relevant postoperative pancreatic stulas (CR-POPFs) are related to increased postoperative hemorrhage, severe infectious complications, and mortality with prolonged hospital stays and expenses 3,4 .…”