Resection for pancreatic cancer in the new millennium |
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| Institution: | 1. Department of Surgery, Haukeland University Hospital, Bergen, Norway;2. Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, Liverpool, UK;1. Applied Physics Section of the Environmental Science Department, University of Lleida, Jaume II 69, 25001, Lleida, Spain;2. University of Corsica, UMR CNRS 6134, Research Centre Georges Peri, Route des Sanguinaires, F-20000 Ajaccio, France;1. State Key Laboratory of Urban Water Resource and Environment, School of Environment, Harbin Institute of Technology, Harbin 150090, PR China;2. Serionix, Inc., 60 Hazelwood Dr., Champaign, IL 61820, United States;3. Division of Nanometrology and Materials Measurement, National Institute of Metrology, Beijing 10029, PR China;4. Department of Materials Science and Engineering, University of Illinois at Urbana-Champaign, 1304 W. Green St., Urbana, IL 61801, United States;1. Foundry, Vancouver, BC, Canada;2. Providence Health Care, Vancouver, BC, Canada;3. Faculty of Medicine, University of British Columbia, Vancouver, BC, Canada;4. Department of Occupational Science and Occupational Therapy, Vancouver, BC, Canada;5. University of British Columbia, Vancouver, BC, Canada;6. Centre for Health Evaluation and Outcome Sciences, Vancouver, BC, Canada;1. Department of Surgery, Kansai Medical University, Osaka, Japan;2. Division of Surgical Oncology, Department of Surgery, University of Colorado of Medicine, Anschutz Medical Campus, Aurora, CO, USA;3. Department of Surgery and Science, Faculty of Medicine, Academic Assembly, University of Toyama, Toyama, Japan;4. Department of Surgery, Nara Medical University, Nara, Japan;5. Department of Surgery, Johns Hopkins University School of Medicine, Baltimore, MD, USA;6. Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg Eppendorf, Hamburg, Germany;7. Department of Surgery and Cancer Research Institute, Seoul National University College of Medicine, Seoul, South Korea;8. Institute of Clinical Medicine, Faculty of Medicine, Vilnius University, Vilnius, Lithuania;9. Department of Surgery, Seoul National University Bundang Hospital, Seongnam, South Korea;10. Department of Surgery, National Cheng Kung University Hospital, Institute of Clinical Medicine, National Cheng Kung University, Tainan, Taiwan;11. Department of General Surgery, Fudan University Zhongshan Hospital, Shanghai, China;12. Department of Surgical and Perioperative Sciences, Umea University, Umea, Sweden;13. Department of Gastroenterology, Kanagawa Cancer Center, Kanagawa, Japan;14. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan;15. Department of Surgery, Kindai University Faculty of Medicine, Osaka, Japan;p. Department of Surgery, Graduate School of Biomedical and Health Sciences, Hiroshima University, Hiroshima, Japan;q. Division of Hepato-Biliary-Pancreatic Surgery and Transplantation, Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan;r. Department of Surgery, Nagahama City Hospital, Shiga, Japan |
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| Abstract: | Background and Aim ofthe Study: Complications of pancreatic resections are dangerous and costly. A literature review was therefore done to investigate the evidence for improving the results by regionalizing this demanding surgery.Results: Studies from four countries (USA, UK, the Netherlands and Finland) with advanced health care systems have shown a significant inverse correlation between case volume for pancreatic cancer resection and post-operative mortality. Further analysis reveals lower complications, reduced hospital stay, reduced hospital costs and improved survival of patients treated in high-volume hospitals. The relationship volume and outcome is with institutional volume rather than single surgeon caseload. The evidence therefore strongly supports the regionalization of pancreatic cancer surgery into large specialized multi-disciplinary units. In the UK, the National Health Service Executive has instructed Regional Health Authorities to concentrate pancreatic cancer surgery into designated Regional Centres ideally with catchment populations of 2–4 million. There is now considerable pressure to adopt a simi-lar policy in all countries with advanced health care systems.Conclusion: There is today enough evidence to advocate the regionalization of pancreatic cancer resections. |
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