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. 2023 Feb 28;14(1):366-378.
doi: 10.21037/jgo-22-649. Epub 2023 Feb 24.

Evolution of pancreatic surgery over time and effects of centralization-a single-center retrospective cohort study

Minna Nortunen  1 , Sanna Meriläinen  1 , Aura Ylimartimo  1 , Pekka Peroja  1 , Heikki Karjula  1 , Jarmo Niemelä  1 , Arto Saarela  1 , Heikki Huhta  1
Affiliations

Evolution of pancreatic surgery over time and effects of centralization-a single-center retrospective cohort study

Minna Nortunen et al. J Gastrointest Oncol. .

Abstract

Background: Short-term outcomes of pancreatic surgery have improved globally during the last two decades. Long-term survival of resectable pancreatic ductal adenocarcinoma (PDAC) has also shown slight improvement. We describe a cohort of 566 consecutive pancreatectomies performed at a Northern Finnish tertiary center. We analyze the trends in short-term outcomes of all-cause pancreatic surgery and long-term survival of PDAC patients.

Methods: All pancreatic resections performed at the Oulu University Hospital during years 2000-2020 were included. Patient data was analyzed in four time periods (2000-2005, 2006-2010, 2011-2015 and 2016-2020). Clinicopathological parameters of patients and tumors, complication data and short-term mortality were recorded for all patients and compared between time quartiles. Long-term survival and administration rates of neo-, and/or adjuvant therapy of PDAC patients were analyzed.

Results: A total of 566 pancreatectomies were performed during the study period: 359 (63%) pancreatoduodenectomies (PDs), 130 (23.0%) open left pancreatectomies (LPs), 45 (8.0%) laparoscopic LPs, 26 (5.1%) total pancreatectomies (TPs), and 6 (1.1%) enucleations. Median age of patients was 63 [57-71] years, and 49% [267] of patients were men. Number of pancreatectomies per time period increased from 67 in 2000-2005 to 266 in 2016-2020. American Society of Anesthesiologists (ASA) Physical Classification III patients and T3 tumors were more frequently operated on in later time periods. Complication rates remained at constant low levels throughout the study period, but reoperation rate increased from 9.4% in 2000-2010 to 16.2% in 2011-2020. Short-term (90-day) mortality after pancreatectomy decreased from 3.1% to 0.74%, while 5-year survival improved from 14.3% in 2006-2011 to 21.4% in 2011-2015. Resection rate of diagnosed PDAC cases, as reported by the Finnish Cancer Registry (FCR) for the catchment area, increased from 3.2% to 14.9% over the study period.

Conclusions: The hospital volume of pancreatectomies has increased substantially, while complications and postoperative mortality have remained at acceptable levels. Long-term survival and resection rate of PDAC patients showed notable improvement over two decades.

Keywords: Pancreatic surgery; centralization of pancreatic surgery; pancreatic cancer.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at https://jgo.amegroups.com/article/view/10.21037/jgo-22-649/coif). HH reports funding from The Finnish Cultural Foundation, Vieno and Alli Suorsa Healthcare Foundation, Georg C. and Mary Ehrnrooth Foundation, Finnish State Research Fund, and Finnish Medical Foundation. The other authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Kaplan-Meier curves of long-term survival, stratified by time quartiles.
Figure 2
Figure 2
Trends in patient and tumor characteristics. (A) ASA; (B) Royal College of Surgeons Charlson Score; (C) stage of pancreatic ductal adenocarcinoma, according to TNM classification of American Joint Committee on Cancer, 8th edition (33); (D) vascular resections. ASA, American Society of Anesthesiologists; RCS, Royal College of Surgeons.
Figure 3
Figure 3
Trends in short-term outcomes. (A) Clavien-Dindo Classification of surgical complications (28); (B) pancreatic fistulas; (C) reoperations; (D) 90-day postoperative mortality. CDC, Clavien-Dindo Classification.
Figure 4
Figure 4
Trends in health care process related metrics. (A) Number of operations; (B) resection rate; (C) length of stay; (D) number of harvested lymph nodes.
See this image and copyright information in PMC

Comment in

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