Improving Outcome for Patients With Pancreatic Cancer Through Centralization

Br J Surg. 2011 Oct;98(10):1455-62. doi: 10.1002/bjs.7581. Epub 2011 Jun 29.

Abstract

Background: High-volume institutions are associated with improved clinical outcomes for pancreatic cancer. This study investigated the impact of centralizing pancreatic cancer surgery in the south of the Netherlands.

Methods: All patients diagnosed in the Eindhoven Cancer Registry area in 1995-2000 (precentralization) and 2005-2008 (implementation of centralization agreements) with primary cancer of the pancreatic head, extrahepatic bile ducts, ampulla of Vater or duodenum were included. Resection rates, in-hospital mortality, 2-year survival and changes in treatment patterns were analysed. Multivariable regression analyses were used to identify independent risk factors for death.

Results: Some 2129 patients were identified. Resection rates increased from 19·0 to 30·0 per cent (P < 0·001). The number of hospitals performing resections decreased from eight to three, and the annual number of resections per hospital increased from two to 16. The in-hospital mortality rate dropped from 24·4 to 3·6 per cent (P < 0·001) and was zero in 2008. The 2-year survival rate after surgery increased from 38·1 to 49·4 per cent (P = 0·001), and the rate irrespective of treatment increased from 10·3 to 16·0 per cent (P < 0·001). There was no improvement in 2-year survival in non-operated patients. After adjustment for relevant patient and tumour factors, those undergoing surgery more recently had a lower risk of death (hazard ratio 0·70, 95 per cent confidence interval 0·51 to 0·97). Changes in surgical patterns seemed largely to explain the improvements.

Conclusion: High-quality care can be achieved in regional hospitals through collaboration. Centralization should no longer be regarded as a threat by general hospitals but as a chance to improve outcomes in pancreatic cancer.

MeSH terms

  • Adult
  • Aged
  • Aged, 80 and over
  • Ampulla of Vater / surgery
  • Bile Duct Neoplasms / mortality
  • Bile Duct Neoplasms / surgery
  • Bile Ducts, Extrahepatic
  • Cancer Care Facilities / organization & administration*
  • Centralized Hospital Services / organization & administration
  • Duodenal Neoplasms / mortality
  • Duodenal Neoplasms / surgery
  • Female
  • Health Facility Size / organization & administration*
  • Humans
  • Interinstitutional Relations
  • Male
  • Middle Aged
  • Netherlands / epidemiology
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / surgery*
  • Quality of Health Care
  • Registries
  • Survival Analysis
  • Treatment Outcome