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. 2025 Aug 25;14(17):6013.
doi: 10.3390/jcm14176013.

Effect of Volume on Postoperative Outcomes After Left Pancreatectomy: A Multicenter Prospective Snapshot Study (SPANDISPAN Project)

Daniel Aparicio-López  1 , José M Ramia  2   3   4 , Celia Villodre  2   3   4 , Juan J Rubio-García  2   3 , Belén Hernández  5 , Juli Busquets  6 , Luis Secanella  6 , Nuria Peláez  6 , Maialen Alkorta  7 , Itziar de-Ariño-Hervás  7 , Mar Achalandabaso  8 , Enrique Toledo-Martínez  8 , Fernando Rotellar  9 , Pablo Martí-Cruchaga  9 , Miguel A Gómez-Bravo  10 , Gonzalo Suárez-Artacho  10 , Marina Garcés-Albir  11 , Luis Sabater  11 , Gabriel García-Plaza  12 , Francisco J Alcalá  12 , Enrique Asensio  13 , David Pacheco  13 , Esteban Cugat  14 , Francisco Espín  14 , María Galófre-Recasens  14 , Belinda Sánchez-Pérez  15 , Julio Santoyo-Santoyo  15 , Jorge Calvo  16 , Carmelo Loinaz  16 , María I García-Domingo  17 , Santiago Sánchez-Cabús  18 , Belén Martín-Arnau  18 , Gerardo Blanco-Fernández  19 , Isabel Jaén-Torrejimeno  19 , Carlos Domingo-Del-Pozo  20 , Carmen Payá  20 , Carmen González  21 , Eider Etxebarría  21 , Rafael López-Andújar  22 , Cristina Ballester  22 , Ana B Vico-Arias  23 , Natalia Zambudio-Carroll  23 , Sergio Estévez  24 , Manuel Nogueira-Sixto  24 , José I Miota  25 , Belén Conde  25 , Miguel A Suárez-Muñoz  26 , Jorge Roldán-de-la-Rua  26 , Angélica Blanco-Rodríguez  27 , Manuel González  27 , Pilar E González-de-Chaves-Rodríguez  28 , Betsabé Reyes-Correa  28 , Santiago López-Ben  29 , Berta Tió  29 , Javier Mínguez  30 , Inmaculada Lasa-Unzué  30 , Alberto Miyar  31 , Lorena Solar  31 , Fernando Burdío  32 , Benedetto Ielpo  32 , Alberto Carabias  33 , María P Sanz-Muñoz  33 , Alfredo Escartín  34 , Fulthon Vela  34 , Elia Marqués  35 , Adelino Pérez  35 , Gloria Palomares  36 , Antonio Calvo-Córdoba  36 , José T Castell  37 , María J Castro  38 , María C Manzanares  39 , Enrique Artigues  40 , Juan L Blas  41 , Luis Díez  42 , Alicia Calero  43 , José Quiñones  44 , Mario Rodríguez  45 , Cándido F Alcázar-López  2   3   4 , Mario Serradilla-Martín  23   46
Affiliations

Effect of Volume on Postoperative Outcomes After Left Pancreatectomy: A Multicenter Prospective Snapshot Study (SPANDISPAN Project)

Daniel Aparicio-López et al. J Clin Med. .

Abstract

Background/Objectives: Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align with the standards established in the literature and assess whether centralization's advantages significantly outweigh its disadvantages. Methods: The SPANDISPAN Project (SPANish DIStal PANcreatectomy) is an observational, prospective, multicenter study focused on LP conducted in Spanish Hepato-Pancreato-Biliary (HPB) Surgery Units from 1 February 2022 to 31 January 2023. HPB units were defined as high volume if they performed more than 10 LPs annually. Results: This study included 313 patients who underwent LP at 42 centers across Spain over the course of a year. A total of 40.3% of the procedures were performed in high-volume centers. Significant differences in preoperative variables were only observed in ASA scores, which were higher in the high-volume group. Intraoperatively, minimally invasive surgical techniques were performed more frequently in high-volume centers. Postoperatively, the administration of somatostatin, major complications, and B and C postoperative pancreatic fistula (POPF) were more frequent in low-volume hospitals. Conclusions: The findings revealed that high-volume centers had a higher rate of minimally invasive surgery, lower intraoperative bleeding, fewer complications, and reduced POPFs compared to low-volume centers. However, it is important to note that low-volume centers still demonstrated acceptable outcomes. Thus, the selective referral of more complex laparoscopic procedures could initiate a gradual centralization of surgical practices.

Keywords: left pancreatectomy; outcomes; regionalization; surgery; volume.

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Conflict of interest statement

Mario Serradilla-Martín received honoraria from Baxter and Sanofi SA as an adviser last year. The rest of the authors declare no conflicts of interest.

Figures

Figure 1
Figure 1
Patients operated on at each participating center in Spain.
See this image and copyright information in PMC

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