Skip to main content
Key Specialties
Cardiology Diabetology Endocrinology Gastroenterology Geriatrics and Gerontology Gynecology and Obstetrics Hematology Infectious Disease Internal Medicine Nephrology Neurology Oncology Pediatrics Respiratory Medicine Rheumatology Surgery
Congress Coverage
2024 ACC Congress 2023 ESMO Congress 2023 EASD Congress 2023 ERS Congress 2023 ESC Congress
Clinical Collections
Advances in Alzheimer’s

At a glance: The STEP trials

A round-up of the STEP phase 3 clinical trials evaluating semaglutide for weight loss in people with overweight or obesity.
ADVANCED SEARCH
Log in
Top
Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 7/2011

Open Access 01-07-2011 | Healthcare Policy and Outcomes

Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands

Authors: Gea A. Gooiker, MD, Lydia G. M. van der Geest, MSc, Michel W. J. M. Wouters, MD, Marieke Vonk, MD, Tom M. Karsten, MD, PhD, Rob A. E. M. Tollenaar, MD, PhD, Bert A. Bonsing, MD, PhD

Published in: Annals of Surgical Oncology | Issue 7/2011

Login to get access

Abstract

Background

Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns.

Materials and Methods

Data of the Comprehensive Cancer Centre West (CCCW) of all 249 patients who had a resection for suspected pancreatic cancer between 1996 and 2008 in the western part of the Netherlands were analyzed. Multivariable modeling was used to evaluate survival for 3 time periods; 1996–2000, 2001–2005 (introduction of quality standards), and 2006–2008 (after centralization). In addition, the differences in referral pattern were analyzed.

Results

From 2006, all pancreatic surgery was centralized in 2 hospitals. The 2-year survival rate increased after centralization from 39% to 55% (P = .09) for all patients who had a pancreatic resection for pancreatic cancer. After adjustment for age, tumor location, stage, histology, and adjuvant treatment, the latter period was significantly associated with improved survival (hazard ratio [HR] 0.50; 95% confidence interval [95% CI] 0.34–0.73).

Conclusions

Centralization of pancreatic surgery was successful and has resulted in improved clinical outcomes in the western part of the Netherlands, demonstrating the effectiveness of centralization.
Literature
1.
Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95:357–62.PubMedCrossRef
2.
Birkmeyer JD, Finlayson SR, Tosteson AN, Sharp SM, Warshaw AL, Fisher ES. Effect of hospital volume on in-hospital mortality with pancreaticoduodenectomy. Surgery. 1999;125:250–6.PubMedCrossRef
3.
Birkmeyer JD, Warshaw AL, Finlayson SR, Grove MR, Tosteson AN. Relationship between hospital volume and late survival after pancreaticoduodenectomy. Surgery. 1999;126:178–83.PubMedCrossRef
4.
Fong Y, Gonen M, Rubin D, Radzyner M, Brennan MF. Long-term survival is superior after resection for cancer in high-volume centers. Ann Surg. 2005;242:540–4; discussion 544–7.PubMed
5.
Simunovic M, To T, Theriault M, Langer B. Relation between hospital surgical volume and outcome for pancreatic resection for neoplasm in a publicly funded health care system. CMAJ. 1999;160:643–8.PubMed
6.
Bilimoria KY, Bentrem DJ, Feinglass JM, Stewart AK, Winchester DP, Talamonti MS, et al. Directing surgical quality improvement initiatives: Comparison of perioperative mortality and long-term survival for cancer surgery. J Clin Oncol. 2008;26:4626–33.PubMedCrossRef
7.
Finlayson EV, Goodney PP, Birkmeyer JD. Hospital volume and operative mortality in cancer surgery: a national study. Arch Surg. 2003;138:721–5; discussion 726.PubMedCrossRef
8.
Urbach DR, Bell CM, Austin PC. Differences in operative mortality between high- and low-volume hospitals in Ontario for 5 major surgical procedures: estimating the number of lives potentially saved through regionalization. CMAJ. 2003;168:1409–14.PubMed
9.
Birkmeyer JD, Finlayson EV, Birkmeyer CM. Volume standards for high-risk surgical procedures: potential benefits of the Leapfrog initiative. Surgery. 2001;130:415–22.PubMedCrossRef
10.
van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, et al. Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg. 2005;242:781–8, discussion 788–90.PubMedCrossRef
11.
Wouters MW, Karim-Kos HE, le Cessie S, Wijnhoven BP, Stassen LP, Steup WH, et al. Centralization of esophageal cancer surgery: does it improve clinical outcome? Ann Surg Oncol. 2009;16:1789–98.PubMedCrossRef
12.
WHO. International classification of diseases for oncology. 3rd ed. Geneva: WHO; 2000.
13.
UICC. TNM classification of malignant tumours. 6th ed. New York: Wiley-Liss; 2002.
14.
Schouten LJ, Hoppener P, van den Brandt PA, Knottnerus JA, Jager JJ. Completeness of cancer registration in Limburg, The Netherlands. Int J Epidemiol. 1993;22:369–76.PubMedCrossRef
15.
Gordon TA, Bowman HM, Tielsch JM, Bass EB, Burleyson GP, Cameron JL. Statewide regionalization of pancreaticoduodenectomy and its effect on in-hospital mortality. Ann Surg. 1998;228:71–8.PubMedCrossRef
16.
Ho V, Heslin MJ, Yun H, Howard L. Trends in hospital and surgeon volume and operative mortality for cancer surgery. Ann Surg Oncol. 2006;13:851–8.PubMedCrossRef
17.
Riall TS, Eschbach KA, Townsend CM, Jr., Nealon WH, Freeman JL, Goodwin JS. Trends and disparities in regionalization of pancreatic resection. J Gastrointest Surg. 2007;11:1242–51 discussion 1251–2.PubMedCrossRef
18.
McPhee JT, Hill JS, Whalen GF, Zayaruzny M, Litwin DE, Sullivan ME, et al. Perioperative mortality for pancreatectomy: a national perspective. Ann Surg. 2007;246:246–53.PubMedCrossRef
19.
Langer B. Role of volume outcome data in assuring quality in HPB surgery. HPB (Oxford). 2007;9:330–34.
20.
Pal N, Axisa B, Yusof S, Newcombe RG, Wemyss-Holden S, Rhodes M, et al. Volume and outcome for major upper GI surgery in England. J Gastrointest Surg. 2008;12:353–7.PubMedCrossRef
21.
Rosemurgy A, Cowgill S, Coe B, Thomas A, Al-Saadi S, Goldin S, et al. Frequency with which surgeons undertake pancreaticoduodenectomy continues to determine length of stay, hospital charges, and in-hospital mortality. J Gastrointest Surg. 2008;12:442–9.PubMedCrossRef
22.
Stitzenberg KB, Sigurdson ER, Egleston BL, Starkey RB, Meropol NJ. Centralization of cancer surgery: implications for patient access to optimal care. J Clin Oncol. 2009;27:4671–8.PubMedCrossRef
23.
Gasper WJ, Glidden DV, Jin C, Way LW, Patti MG. Has recognition of the relationship between mortality rates and hospital volume for major cancer surgery in California made a difference?: A follow-up analysis of another decade. Ann Surg. 2009;250:472–83.PubMed
24.
Birkmeyer JD, Siewers AE, Marth NJ, Goodman DC. Regionalization of high-risk surgery and implications for patient travel times. JAMA. 2003;290:2703–8.PubMedCrossRef
25.
Bilimoria KY, Talamonti MS, Wayne JD, Tomlinson JS, Stewart AK, Winchester DP, et al. Effect of hospital type and volume on lymph node evaluation for gastric and pancreatic cancer. Arch Surg. 2008;143:671–8; discussion 678.PubMedCrossRef
26.
Bilimoria KY, Talamonti MS, Sener SF, Bilimoria MM, Stewart AK, Winchester DP, et al. Effect of hospital volume on margin status after pancreaticoduodenectomy for cancer. J Am Coll Surg. 2008;207:510–9.PubMedCrossRef
27.
Makowiec F, Post S, Saeger HD, Senninger N, Becker H, Betzler M, et al. Current practice patterns in pancreatic surgery: results of a multi-institutional analysis of seven large surgical departments in Germany with 1454 pancreatic head resections, 1999 to 2004 (German Advanced Surgical Treatment study group). J Gastrointest Surg. 2005;9:1080–6; discussion 1086–7.PubMedCrossRef
28.
Dimick JB, Pronovost PJ, Cowan JA, Jr., Lipsett PA, Stanley JC, Upchurch GR, Jr. Variation in postoperative complication rates after high-risk surgery in the United States. Surgery. 2003;134:534–40; discussion 540–1.PubMedCrossRef
29.
Wouters MW, Wijnhoven BP, Karim-Kos HE, Blaauwgeers HG, Stassen LP, Steup WH, et al. High-volume versus low-volume for esophageal resections for cancer: the essential role of case-mix adjustments based on clinical data. Ann Surg Oncol. 2008;15:80–7.PubMedCrossRef
30.
Khuri SF, Daley J, Henderson WG. The comparative assessment and improvement of quality of surgical care in the Department of Veterans Affairs. Arch Surg. 2002;137:20–7.PubMedCrossRef
31.
Joseph B, Morton JM, Hernandez-Boussard T, Rubinfeld I, Faraj C, Velanovich V. Relationship between hospital volume, system clinical resources, and mortality in pancreatic resection. J Am Coll Surg. 2009;208:520–7.PubMedCrossRef
32.
Birkmeyer JD, Sun Y, Goldfaden A, Birkmeyer NJ, Stukel TA. Volume and process of care in high-risk cancer surgery. Cancer. 2006;106:2476–81.PubMedCrossRef
33.
Bilimoria KY, Bentrem DJ, Ko CY, Tomlinson JS, Stewart AK, Winchester DP, et al. Multimodality therapy for pancreatic cancer in the U.S.: utilization, outcomes, and the effect of hospital volume. Cancer. 2007;110:1227–34.
34.
Evidence Based Hospital Referral Factsheet 3.0. Washington DC: Leapfrog Group; 2008.
Metadata
Title
Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands
Authors
Gea A. Gooiker, MD
Lydia G. M. van der Geest, MSc
Michel W. J. M. Wouters, MD
Marieke Vonk, MD
Tom M. Karsten, MD, PhD
Rob A. E. M. Tollenaar, MD, PhD
Bert A. Bonsing, MD, PhD
Publication date
01-07-2011
Publisher
Springer-Verlag
Published in
Annals of Surgical Oncology / Issue 7/2011
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-010-1511-4

Other articles of this Issue 7/2011

Annals of Surgical Oncology 7/2011 Go to the issue

Hepatobiliary Tumors

Surgical Treatment of Renal Cell Cancer Liver Metastases: A Population-Based Study

Endocrine Tumors

Minimal Extrathyroidal Extension in Patients with Papillary Thyroid Microcarcinoma: Is It a Real Prognostic Factor?

Gastrointestinal Oncology

Comparison of 6th and 7th AJCC TNM Staging Classification for Carcinoma of the Stomach in China

Breast Oncology

Spacer Balloons prior to Partial Breast Irradiation: Helpful or Hurtful?

Bone and Soft Tissue Sarcomas

Functional Outcome of Arthrodesis with a Vascularized Fibular Graft and a Rotational Latissimus Dorsi Flap After Proximal Humerus Sarcoma Resection

Colorectal Cancer

Outcome of Laparoscopic Resection for Colorectal Cancer in Patients with High Operative Risk