Facility volume-survival relationship in patients with early-stage pancreatic adenocarcinoma treated with neoadjuvant chemotherapy followed by pancreatoduodenectomy
| Autor: | Lee M. Ocuin, Jordan M. Winter, Sarah C. Markt, John B. Ammori, Jeffrey M. Hardacre, Jonathan J. Hue, Luke D. Rothermel, Kavin Sugumar |
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| Rok vydání: | 2021 |
| Předmět: |
Male
medicine.medical_specialty Hospitals Low-Volume Surgicenters medicine.medical_treatment Kaplan-Meier Estimate Adenocarcinoma 030230 surgery Pancreaticoduodenectomy 03 medical and health sciences 0302 clinical medicine medicine Humans In patient Stage (cooking) Propensity Score Neoadjuvant therapy Aged Neoplasm Staging Proportional Hazards Models Chemotherapy business.industry Cancer Middle Aged medicine.disease Neoadjuvant Therapy Surgery Pancreatic Neoplasms Chemotherapy Adjuvant 030220 oncology & carcinogenesis Pancreatectomy Propensity score matching Female business Hospitals High-Volume |
| Zdroj: | Surgery. 170:207-214 |
| ISSN: | 0039-6060 |
| DOI: | 10.1016/j.surg.2020.12.003 |
| Popis: | There is evidence that neoadjuvant therapy is associated with improved survival compared with upfront pancreatectomy for pancreatic adenocarcinoma. Treatment at high-volume pancreatic surgery centers is associated with improved short-term postoperative outcomes compared with low-volume centers. We compared overall survival of patients with early-stage pancreatic adenocarcinoma who received neoadjuvant therapy before resection stratified by facility volume.Patients with clinical T0 to T2 pancreatic adenocarcinoma who received neoadjuvant therapy before pancreatoduodenectomy were identified in the National Cancer Database (2010-2016). High-volume pancreatic surgery centers performed ≥36 pancreatectomies/year. Patients were matched 1:1 by propensity score. Pathologic outcomes, postoperative outcomes, and overall survival were compared.Before matching, 1,449 patients were treated at low-volume centers and 250 at high-volume pancreatic surgery centers. After matching, there were 177 patients per group. High-volume pancreatic surgery centers were more commonly academic/research facilities (99.4% vs 54.0%; P.001), and patients traveled greater distances (65 vs 13 miles; P.001). Time from diagnosis to neoadjuvant therapy and surgery was similar. Treatment at high-volume pancreatic surgery centers was associated with shorter duration of stay (7 vs 8 days; P = .003) and lower 90-day mortality rate after pancreatoduodenectomy (0.0% vs 5.0%; P = .01). Patients treated at high-volume pancreatic surgery centers had improved overall survival (36.3 vs 29.4 months; P = .03; hazard ratio 0.73). On subset analysis of academic/research facilities, high-volume pancreatic surgery centers remained associated with shorter duration of stay, lower 90-day mortality, and greater overall survival.The majority of patients treated with neoadjuvant therapy for early-stage pancreatic adenocarcinoma received care at low-volume centers. Treatment at high-volume pancreatic surgery centers was associated with improved overall survival and short-term postoperative outcomes. |
| Databáze: | OpenAIRE |
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