Pancreatectomy is underused in NSW regions with low institutional surgical volumes: a population data linkage study

Abstract

Objective: To examine differences in the proportions of people diagnosed with pancreatic cancer who underwent pancreatectomy, post‐operative outcomes and 5‐year survival in different New South Wales administrative health regions of residence. Design, setting and participants: Retrospective analysis of NSW data on pancreatic cancer incidence and surgery, 2005–2013. Main outcome measures: The proportion of newly diagnosed patients with pancreatic cancer who were resected in each region; 90‐day post‐operative mortality; one‐year post‐operative survival; 5‐year post‐diagnosis survival. Results: 14% of people diagnosed with pancreatic cancer during 2010–2013 (431 of 3064) underwent pancreatectomy, an average of 108 resections per year. After adjusting for age, sex and comorbidities, the proportion that underwent resection varied significantly between regions, ranging between 8% and 21% (P<0.001). Higher resection rates were not associated with higher post‐operative 90‐day mortality or lower one‐year survival (unadjusted and risk‐adjusted analyses). Higher resection rates were associated with higher 5‐year post‐diagnosis survival: the mean survival in regions with resection rates below 10% was 3.4%, compared with 7.2% in regions with rates greater than 15% (unadjusted and adjusted survival analyses; P<0.001). There was a positive association between regional resection rate and the pancreatectomy volume of hospitals during 2005–2009. An additional 32 people would be resected annually if resection rates in low rate regions were increased to the 80th percentile regional resection rate (18%). Conclusion: There is significant geographic variation in the proportion of people with pancreatic cancer undergoing pancreatectomy, and the 5‐year survival rate is higher in regions where this proportion is higher.

Pushing the boundaries of pelvic exenteration by maintaining survival at the cost of morbidity

“…A relationship between volume and outcome in colorectal cancer surgery has been suggested previously; patients treated at hospitals with high‐volume colorectal cancer surgery and by high‐volume surgeons have been shown to have a clear long‐term (up to 6 years) survival advantage and postoperative mortality rate. Such findings are consistent across other surgical specialties, including gynaecological, pancreatic and prostate cancer surgery, at both the surgeon and hospital level. This has led to many countries centralizing highly complex surgical procedures at high‐volume centres in order to streamline services, improve oncological and patient‐reported outcomes, and lower healthcare costs.…”

Pancreatic cancer in the Australian population: identifying opportunities for intervention

“…The study by McWilliams et al 33 was excluded from the present review as it is an international study based on data from the Pancreatic Cancer Case-Control Consortium and so was the study by Ansari-Moghaddam et al 28 as it contains data collated from countries in the Asia-Pacific region. Thus, 22 studies [19][20][21][22][23][24][25][26][27][29][30][31][32][34][35][36][37][38][39][40][41][42] were included in the review. Table 1 lists the various studies included in the review highlighting the source of their information.…”

Centralising care for patients with pancreatic cancer: a hybrid model approach

“…While a global approach would be beneficial, “improving awareness of and access to specialist centres” 5 is unlikely to significantly improve outcomes for people with pancreatectomy. Widespread education of the population will increase the numbers of patients who present with localised disease, but widespread screening is still many years away.…”

“…In the study published in this issue of the MJA , 5 Creighton and colleagues analysed data collated from several retrospective sources and compiled by the Centre for Health Care Linkage. In New South Wales, considerable variation between local health districts in the rates of curative intent treatment for pancreatic cancer was identified.…”

“…Advances in pancreatectomy techniques have increased the numbers of patients who can undergo curative surgery; despite this rise in numbers, morbidity and mortality rates have fallen. The volume–outcome relationship was also investigated by Creighton and her co‐authors, with medium and higher volume centres (six or more resections per year) having higher survival rates, a finding that makes the case for centralising pancreatectomy procedures 5 …”