Regional Oncology Network Between Pancreatic Centers Safeguards Waiting Times for Pancreatoduodenectomy

Overview

Journal Updates Surg

Specialty General Surgery

Date 2019 Sep 12

PMID 31506895

Citations 1

Authors

M Willemijn Steen

Claire van Vliet

Sebastiaan Festen

Marc G Besselink

Michael F Gerhards

Olivier R Busch

Affiliations

Soon will be listed here.

Abstract

Pancreatoduodenectomy (PD) is increasingly performed in high-volume centers, which may compromise waiting times. The aim of this study was to evaluate patient flow and outcome of PD within a regional oncology network of two high-volume centers. A post hoc analysis of a partially retrospective and prospective database was performed of all patients who underwent PD for pancreatic or periampullary neoplasms in both centers of the Gastrointestinal Oncology Center Amsterdam, a collaboration between an academic center and affiliated general teaching hospital, from 2010 to 2014. Outcomes included waiting time to surgery and postoperative morbidity and mortality. A total of 525 PDs were performed, 329 in the academic center (annual volume 66) and 196 in the teaching hospital (annual volume 39). Neoadjuvant treatment was more often used in the academic center, other baseline characteristics were similar. Overall time to surgery was 26 days, which was significantly less in the teaching hospital. The major postoperative morbidity rate was 38.3% (n = 201), and the 30- and 90-day mortality was 2.3% and 3.6%. A regional oncology network between an academic center and a general teaching hospital for PD can be an attractive option to safeguard waiting times in selected patients, without compromising outcome.

Citing Articles

Transduodenal surgical ampullectomy: a procedure that requires a multidisciplinary approach.

di Mola F, Panaccio P, Grottola T, De Bonis A, Sapia G, Farrukh M Updates Surg. 2021; 73(6):2215-2223.

PMID: 33387169 DOI: 10.1007/s13304-020-00951-y.

References

Oudhoff J, Timmermans D, Knol D, Bijnen A, van der Wal G . Waiting for elective general surgery: impact on health related quality of life and psychosocial consequences. BMC Public Health. 2007; 7:164. PMC: 1959190. DOI: 10.1186/1471-2458-7-164. View

Van Der Gaag N, Rauws E, van Eijck C, Bruno M, van der Harst E, Kubben F . Preoperative biliary drainage for cancer of the head of the pancreas. N Engl J Med. 2010; 362(2):129-37. DOI: 10.1056/NEJMoa0903230. View

Swan R, Niemeyer D, Seshadri R, Thompson K, Walters A, Martinie J . The impact of regionalization of pancreaticoduodenectomy for pancreatic Cancer in North Carolina since 2004. Am Surg. 2014; 80(6):561-6. View

Koch M, Garden O, Padbury R, Rahbari N, Adam R, Capussotti L . Bile leakage after hepatobiliary and pancreatic surgery: a definition and grading of severity by the International Study Group of Liver Surgery. Surgery. 2011; 149(5):680-8. DOI: 10.1016/j.surg.2010.12.002. View

Are C, Afuh C, Ravipati L, Sasson A, Ullrich F, Smith L . Preoperative nomogram to predict risk of perioperative mortality following pancreatic resections for malignancy. J Gastrointest Surg. 2009; 13(12):2152-62. DOI: 10.1007/s11605-009-1051-z. View

Basta Y, Baur O, van Dieren S, Klinkenbijl J, Fockens P, Tytgat K . Is there a Benefit of Multidisciplinary Cancer Team Meetings for Patients with Gastrointestinal Malignancies?. Ann Surg Oncol. 2016; 23(8):2430-7. PMC: 4927602. DOI: 10.1245/s10434-016-5178-3. View

Van Heek N, Kuhlmann K, Scholten R, de Castro S, Busch O, van Gulik T . Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005; 242(6):781-8, discussion 788-90. PMC: 1409869. DOI: 10.1097/01.sla.0000188462.00249.36. View

Wente M, Bassi C, Dervenis C, Fingerhut A, Gouma D, Izbicki J . Delayed gastric emptying (DGE) after pancreatic surgery: a suggested definition by the International Study Group of Pancreatic Surgery (ISGPS). Surgery. 2007; 142(5):761-8. DOI: 10.1016/j.surg.2007.05.005. View

van der Geest L, van Rijssen L, Molenaar I, de Hingh I, Groot Koerkamp B, Busch O . Volume-outcome relationships in pancreatoduodenectomy for cancer. HPB (Oxford). 2016; 18(4):317-24. PMC: 4814615. DOI: 10.1016/j.hpb.2016.01.515. View

10.

Derrett S, Paul C, Morris J . Waiting for elective surgery: effects on health-related quality of life. Int J Qual Health Care. 1999; 11(1):47-57. DOI: 10.1093/intqhc/11.1.47. View

11.

Bassi C, Dervenis C, Butturini G, Fingerhut A, Yeo C, Izbicki J . Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005; 138(1):8-13. DOI: 10.1016/j.surg.2005.05.001. View

12.

de Wilde R, Besselink M, van der Tweel I, de Hingh I, van Eijck C, Dejong C . Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg. 2012; 99(3):404-10. DOI: 10.1002/bjs.8664. View

13.

Eshuis W, Van Der Gaag N, Rauws E, van Eijck C, Bruno M, Kuipers E . Therapeutic delay and survival after surgery for cancer of the pancreatic head with or without preoperative biliary drainage. Ann Surg. 2010; 252(5):840-9. DOI: 10.1097/SLA.0b013e3181fd36a2. View

14.

Sanjeevi S, Ivanics T, Lundell L, Kartalis N, Andren-Sandberg A, Blomberg J . Impact of delay between imaging and treatment in patients with potentially curable pancreatic cancer. Br J Surg. 2015; 103(3):267-75. DOI: 10.1002/bjs.10046. View

15.

Sampalis J, Boukas S, Liberman M, Reid T, Dupuis G . Impact of waiting time on the quality of life of patients awaiting coronary artery bypass grafting. CMAJ. 2001; 165(4):429-33. PMC: 81367. View

16.

Raptis D, Fessas C, Belasyse-Smith P, Kurzawinski T . Clinical presentation and waiting time targets do not affect prognosis in patients with pancreatic cancer. Surgeon. 2010; 8(5):239-46. DOI: 10.1016/j.surge.2010.03.001. View

17.

Wente M, Veit J, Bassi C, Dervenis C, Fingerhut A, Gouma D . Postpancreatectomy hemorrhage (PPH): an International Study Group of Pancreatic Surgery (ISGPS) definition. Surgery. 2007; 142(1):20-5. DOI: 10.1016/j.surg.2007.02.001. View

18.

Verbeke C, Leitch D, Menon K, McMahon M, Guillou P, Anthoney A . Redefining the R1 resection in pancreatic cancer. Br J Surg. 2006; 93(10):1232-7. DOI: 10.1002/bjs.5397. View

19.

Gooiker G, Lemmens V, Besselink M, Busch O, Bonsing B, Molenaar I . Impact of centralization of pancreatic cancer surgery on resection rates and survival. Br J Surg. 2014; 101(8):1000-5. DOI: 10.1002/bjs.9468. View

20.

Venkat R, Puhan M, Schulick R, Cameron J, Eckhauser F, Choti M . Predicting the risk of perioperative mortality in patients undergoing pancreaticoduodenectomy: a novel scoring system. Arch Surg. 2011; 146(11):1277-84. DOI: 10.1001/archsurg.2011.294. View