Abstract
Introduction
Resection is the cornerstone of curative management for pancreatic ductal adenocarcinoma
(PDAC). Hospital surgical volume influence post-operative mortality. Few is known
about impact on survival.
Methods
Population included 763 patients resected for PDAC within the 4 French digestive tumor
registries between 2000 and 2014. Spline method was used to determine annual surgical
volume thresholds influencing survival. A multilevel survival regression model was
used to study center effect.
Results
Population was divided into three groups: low-volume (LVC) (<41 hepatobiliary/pancreatic
procedures/year), medium-volume (MVC) (41–233) and high-volume centers (HVC) (>233).
Patients in LVC were older (p = 0.02), had a lower rate of disease-free margins (76.7%
vs. 77.2% and 69.5%, p = 0.028) and a higher post-operative mortality than in MVC
and HVC (12.5% and 7.5% vs. 2.2%; p = 0.004). Median survival was higher in HVC than
in other centers (25 vs. 15.2 months, p < 0.0001). Survival variance attributable
to center effect accounted for 3.7% of total variance. In multilevel survival analysis,
surgical volume explained the inter-hospital survival heterogeneity (non-significant
variance after adding the volume to the model p = 0.3). Patients resected in HVC had
a better survival than in LVC (HR 0.64 [0.50–0.82], p < 0.0001). There was no difference
between MVC and HVC.
Conclusion
Regarding center effect, individual characteristics had little impact on survival
variability across hospitals. Hospital volume was a major contributor to the center
effect. Given the difficulty of centralizing pancreatic surgery, it would be wise
to determine which factors would indicate management in a HVC.
Keywords
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Article info
Publication history
Published online: April 07, 2023
Accepted:
March 24,
2023
Received in revised form:
January 23,
2023
Received:
October 18,
2022
Publication stage
In Press Journal Pre-ProofIdentification
Copyright
© 2023 Elsevier Ltd, BASO ~ The Association for Cancer Surgery, and the European Society of Surgical Oncology. All rights reserved.
