Effectiveness of Oncology Network model in pancreas cancer surgery in Piedmont, IT: a survival study

Abstract

Background The Oncology Network of Piedmont and Aosta Valley (North-West Italy) was started in 2000 and fully established in 2010 as a regional organisational model offering multidisciplinary care by experienced reference centres for cancer diagnosis and surgical treatment. In particular, the San Giovanni Bosco Hospital in Turin is the regional reference centre for pancreatic cancer since 2015 (50-70 oncologic surgery operations performed annually). The aim of study is to assess the effectiveness of this model for pancreatic cancer surgery by comparing survival outcomes before and after the adoption of the Oncology Network model. Methods The study included 178 patients, aged 37-84, who underwent duodenocephalo- or total pancreatectomy for ductal cancer in the years 2007-2019. Clinical data were retrieved from surgical records, whereas the vital status was ascertained through an application connected to the Regional Registry Office. The Kaplan-Meier method was used to estimate survival and the log-rank test was then used to compare survival rates between the two groups (before vs. after 2015). Cox's regression was employed to assess the difference between the groups, also adjusting for age, sex and ASA score. Results The median survival for included patients was 19 months. No significant differences were found between patients of the two groups (before vs. after 2015), neither considering all patients (p = 0.4) nor for any single ASA or age category (p-values ranging from 0.1 to 0.6). The multivariate Cox model accounting for ASA, age and sex confirmed absence of significant survival differences between the two groups. Conclusions Despite increased case complexity, due to the extension of surgery indication to more critical patients, the Oncology Network model allowed achieving an overall survival in pancreatic cancer surgery that is consistent with international literature and not inferior to survival outcomes previously reached in patients more strictly selected. Key messages This study found survival after pancreatic cancer surgery was similar before and after the center entered an Oncological Network, which led to include patients with an increased severity in case-mix. Promoting the implementation of Oncology Networks should be a public health priority as it allows to improve health outcomes and quality of care.