Hospital volume and outcomes of pancreatic cancer: a Finnish population-based nationwide study |
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| Affiliation: | 1. Surgery and Intensive Care Research Unit, Oulu University Hospital, Oulu, Finland;2. Upper Gastrointestinal Surgery, Department of Molecular Medicine and Surgery, Karolinska Institutet, and Karolinska University Hospital, Stockholm, Sweden;1. Excellence Center for Gastrointestinal Endoscopy and Division of Gastroenterology, Department of Medicine, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society;2. Pancreas Research Unit, Department of Medicine, Faculty of Medicine, Chulalongkorn University;3. Division of Hospital and Ambulatory Medicine, Department of Medicine, Faculty of Medicine, Chulalongkorn University;4. Tropical Medicine Cluster, Chulalongkorn University;5. Department of Pathology, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;6. Department of Surgery, Section of Surgical Endoscopy and Minimally Invasive Surgery, Rizal Medical Center, Philippines;7. Department of Anatomy, Faculty of Medicine, Chulalongkorn University and King Chulalongkorn Memorial Hospital, Thai Red Cross Society, Bangkok, Thailand;1. Division of Transplant Anesthesia, Department of Anesthesia and Perioperative Medicine, 500 University Drive, Hershey, PA, 17033, USA;2. Liver Center, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA;3. Department of Public Health Sciences, The Pennsylvania State University, College of Medicine, 500 University Drive, Hershey, PA, 17033, USA;4. Division of Gastroenterology and Hepatology, Department of Medicine, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA;5. Cancer Institute, The Pennsylvania State University, Milton S. Hershey Medical Center, 500 University Drive, Hershey, PA, 17033, USA;1. Clarunis, University Centre for Gastrointestinal and Liver Diseases, Postfach, 4002, Basel, Switzerland;2. University of Basel, Faculty of Medicine, Klingelbergstrasse 61, 4056, Basel, Switzerland;3. Institute of Medical Genetics and Pathology, University Hospital Basel, Schönbeinstrasse 40, 4056, Basel, Switzerland;4. Institute of Radiology, University Hospital Basel, Petersgraben 4, 4051, Basel, Switzerland;5. Institute of Radiology, St. Clara Hospital Basel, Kleinriehenstrasse 30, 4058, Basel, Switzerland;1. Department of Surgery, Division of Surgical Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;2. Department of Population and Qualitative Health Sciences, Case Western Reserve University School of Medicine, Cleveland, OH, USA;3. Department of Surgery, Division of Surgical Oncology, University of Pittsburgh, Pittsburgh, PA, USA;4. Department of Medicine, Division of Hematology/Oncology, University Hospitals Cleveland Medical Center, Cleveland, OH, USA;5. Department of Surgery, Division of Transplant Surgery, University Hospitals Cleveland Medical Center, Cleveland, OH, USA |
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| Abstract: | ![]()
BackgroundPancreatic cancer surgery is associated with high incidence of short- and long-term morbidity and mortality. The aim of this study was to assess whether the hospital volume of pancreatic surgery is associated with better survival in a population-based setting.MethodsAll patients who underwent pancreatic resection for cancer in Finland during 1997–2016 were identified from nationwide registries. The follow-up ended on 31 December 2019. Patients were divided into quintiles based on annual hospital volume (4-year moving average): ≤4, 5–9, 10–18, 19–36 and ≥ 37 resections per year. Cox regression provided hazard ratios (HR) and 95% confidence intervals (CI), adjusted for age, sex, comorbidity and year of surgery.ResultsThe number of diagnosed pancreatic cancers was 22,724. Of these, 1514 underwent pancreatic surgery due to pancreatic ductal adenocarcinoma. The 5-year survival ranged from 12% to 28%, increasing with higher annual operative volume. Adjusted 5-year mortality was higher in all other quintiles compared to the highest annual volume quintile (HR 1.43, 95% CI 1.16–1.75). Thirty and 90-day mortality were higher in the three lowest volume, compared to the highest quintile.ConclusionHigher annual hospital volume of pancreatic surgery for pancreatic ductal adenocarcinoma is associated with improved short- and long-term survival. |
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