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National Trends in Centralization of Surgical Care and Multimodality Therapy for Pancreatic Adenocarcinoma

  • Original Article
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Journal of Gastrointestinal Surgery

Abstract

Background

Studies have demonstrated that multimodality therapy and surgery at high volume centers are associated with a longer survival. However, it is unknown if these data have translated into national changes in care delivery.

Methods

Patients with stages I–III pancreatic adenocarcinomas who underwent resections between 2004 and 2010 were identified from the National Cancer Data Base. The primary outcome was a 3-year overall survival. Temporal trends in survival outcomes and treatment variables were measured. A mediation analysis using the Lin method was used to discern the relative contribution of changes in treatment variables towards improvements in survival over time.

Results

A total of 22,196 patients were identified. Between 2004 and 2010, a 90-day peri-operative mortality remained unchanged (8.5 % to 8.4 %, p = 0.488), 3-year overall survival improved from 26 to 30% (p < 0.001), use of adjuvant/neoadjuvant chemotherapy increased (51 % to 61 %, p < 0.001), and more cases shifted to high volume centers (46 % at institutions performing > 10 cases/year in 2004 vs. 65 % in 2010, p < 0.001). On multivariable analysis, 32 % of the improvement in survival over time was attributable to receipt of chemotherapy, while 12 % was due to the shift of patients towards high volume centers (p < 0.001).

Conclusions

Over the period from 2004 to 2010, a 3-year survival increased for patients undergoing resection for pancreatic cancer. This survival improvement can be partially attributed to the increasing utilization of chemotherapy and centralization of surgical care at high volume centers. A continued emphasis on these factors will likely result in further prolongation of a survival following resection.

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Authors and Affiliations

  1. Department of Surgery, University of Wisconsin, 600 Highland Avenue, BX7375 Clinical Science Center, Madison, WI, 53792-3284, USA

    Alexander V. Fisher, Xing Wang, Stephanie A. Campbell-Flohr, Sean M. Ronnekleiv-Kelly, Daniel E. Abbott & Sharon M. Weber

  2. Department of Medicine, University of Wisconsin, Madison, WI, USA

    Yue Ma

  3. Department of Biostatistics and Medical Informatics, University of Wisconsin, Madison, WI, USA

    Paul J. Rathouz

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  1. Alexander V. Fisher
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Contributions

Alexander V. Fisher made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

Yue Ma made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

Xiang Wang made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

Stephanie A. Campbell-Flohr made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

Paul Rathouz made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

Sean Ronnekleiv-Kelly made a substantial contribution to study design, data interpretation, and manuscript revision.

Daniel E. Abbott made a substantial contribution to study design, data interpretation, and manuscript revision.

Sharon M. Weber made a substantial contribution to study conception and design, data analysis and interpretation, and manuscript drafting and revision.

All authors gave a final approval of the version to be published and agree to be accountable for all aspects of the work.

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Correspondence to Sharon M. Weber.

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Fisher, A.V., Ma, Y., Wang, X. et al. National Trends in Centralization of Surgical Care and Multimodality Therapy for Pancreatic Adenocarcinoma. J Gastrointest Surg 24, 2021–2029 (2020). https://doi.org/10.1007/s11605-019-04361-3

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  • DOI: https://doi.org/10.1007/s11605-019-04361-3

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