Strengths, Weaknesses, Opportunities, and Threats of Centralized Pancreatic Surgery: A Single-Center Analysis of 3000 Consecutive Pancreatic Resections

J Gastrointest Surg. 2019 Mar;23(3):492-502. doi: 10.1007/s11605-018-3867-x. Epub 2018 Sep 4.

Abstract

Background: Pancreatic surgery at high-volume centers has undergone major changes over the last decades. However, the quality of surgery remains to be considered as one important factor for achieving long-term survival especially in patients at advanced stages of disease.

Methods: Between January 1990 and June 2017, 3000 consecutive patients have undergone pancreatic resections at our institution. Relevant postoperative data and histopathological findings as well as overall survival were analyzed. In addition, a SWOT (strengths, weaknesses, opportunities, threats) analysis of pancreatic surgery at high-volume centers was performed.

Results: A total of 2218 pancreatic head resections (74%), 494 distal pancreatectomies (16%), 200 total pancreatectomies (7%), and 88 other resections (3%) were performed within our study period. Despite additional vascular resections in 265 patients (9%) and additional liver resections in 167 patients (6%), overall perioperative mortality did not exceed 3%. Overall survival strongly depended on the underlying disease, as well as on lymph node stage (p = < 0.001) and surgical radicality (p = < 0.001).

Conclusions: The decentralization of pancreatic surgery over the last decades has led to a focus on high-volume centers to perform extended procedures in complex patients. The present SWOT analysis underlines the significance of a centralization of pancreatic surgery for patient safety and to increase the chance of long-term survival.

Keywords: Centralization; High-volume center; Pancreatic surgery; SWOT analysis.

MeSH terms

  • Adult
  • Aged
  • Female
  • Hepatectomy
  • Hospitalization
  • Humans
  • Male
  • Middle Aged
  • Pancreatectomy / adverse effects
  • Pancreatectomy / mortality
  • Pancreatectomy / statistics & numerical data*
  • Pancreatic Neoplasms / mortality
  • Pancreatic Neoplasms / pathology
  • Pancreatic Neoplasms / surgery*
  • Postoperative Complications / epidemiology*
  • Reoperation
  • Retrospective Studies
  • Survival Rate