Skip to main content
SpringerLink
Log in

Pancreatic surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it

  • Position Paper
  • Published:
Updates in Surgery Aims and scope Submit manuscript

Abstract

Indicators of effectiveness and quality of care are urgently needed to improve the surgical outcomes. This is particularly felt in the field of complex surgical fields, such as the HPB one. International and national studies have documented an association between the large number of pancreatic surgical procedures and the outcome quality. The aim of this paper is to suggest reliable structural requirements and surgical volume to support pancreatic surgical accreditation, preserving patient’s safety. Moreover, an accreditation program is outlined.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. SEER Stat Fact Sheets: Pancreas Cancer. http://seer.cancer.gov/statfacts/html/pancreas.html

  2. Cancer Research UK, http://www.cancerresearchuk.org/health-professional/cancer-statistics/statistics-by-cancer-type/pancreatic-cancer. Accessed March 2016

  3. Istat—Istituto Nazionale di Statistica, Principali cause di morte in Italia–Anno (2012) http://www.istat.it/it/files/2014/12/Principali_cause_morte_2012.pdf?title=Principali+cause+di+morte+in+Italia+-+03%2Fdic%2F2014+-+Testo+integrale.pdf. Accessed June 2015

  4. Lee KS, Sekhar A, Rofsky NM, Pedrosa I (2010) Prevalence of incidental pancreatic cysts in the adult population on MR imaging. Am J Gastroenterol 105:2079–2084

    Article  PubMed  Google Scholar 

  5. Zhang XM, Mitchell DG, Dohke M et al (2002) Pancreatic cysts: depiction on single-shot fast spin-echo MR images. Radiology 223:547–553

    Article  PubMed  Google Scholar 

  6. Yao JC, Hassan M, Phan A, Dagohoy C, Leary C, Mares JE, Abdalla EK, Fleming JB, Vauthey JN, Rashid A, Evans DB (2008) One hundred years after “carcinoid”: epidemiology of and prognostic factors for neuroendocrine tumors in 35,825 cases in the United States. J Clin Oncol 26:3063–3072

    Article  PubMed  Google Scholar 

  7. Jensen RT, Cadiot G, Brandi ML, de Herder WW, Kaltsas G, Komminoth P, Scoazec JY, Salazar R, Sauvanet A, Kianmanesh R, Barcelona Consensus Conference participants (2012) ENETS consensus guidelines for the management of patients with digestive neuroendocrine neoplasms: functional pancreatic endocrine tumor syndromes. Neuroendocrinology 95:98–119

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  8. Franko J, Feng W, Yip L, Genovese E, Moser AJ (2010) Non-functional neuroendocrine carcinoma of the pancreas: incidence, tumor biology, and outcomes in 2,158 patients. J Gastrointest Surg 14:541–548

    Article  PubMed  Google Scholar 

  9. Cameron JL, He J (2015) Two thousand consecutive pancreaticoduodenectomies. J Am Coll Surg 220:530–536

    Article  PubMed  Google Scholar 

  10. Malleo G, Salvia R, Mascetta G, Esposito A, Landoni L, Casetti L, Maggino L, Bassi C, Butturini G (2014) Assessment of a complication risk score and study of complication profile in laparoscopic distal pancreatectomy. J Gastrointest Surg 18:2009–2015

    Article  PubMed  Google Scholar 

  11. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I et al (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346:1128–1137

    Article  PubMed  Google Scholar 

  12. Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V (2008) Effect of hospital volume on the outcome of pancreaticoduodenectomy in Italy. Br J Surg 95:357–362

    Article  CAS  PubMed  Google Scholar 

  13. Nathan H, Cameron JL, Choti MA, Schulick RD, Pawlik TM (2009) The volume-outcomes effect in hepato-pancreato-biliary surgery: hospital versus surgeon contributions and specificity of the relationship. J Am Coll Surg 208:528–538

    Article  PubMed  Google Scholar 

  14. Birkmeyer JD, Stukel TA, Siewers AE, Goodney PP, Wennberg DE, Lucas FL (2003) Surgeon volume and operative mortality in the United States. N Engl J Med 349:2117–2127

    Article  CAS  PubMed  Google Scholar 

  15. Eppsteiner RW, Csikesz NG, McPhee JT, Tseng JF, Shah SA (2009) Surgeon volume impacts hospital mortality for pancreatic resection. Ann Surg 249:635–640

    Article  PubMed  Google Scholar 

  16. Pecorelli N, Balzano G, Capretti G, Zerbi A, DiCarlo V, Braga M (2012) Effect of surgeon volume on outcome following pancreaticoduodenectomy in a high-volume hospital. J Gastrointest Surg 16:518–523

    Article  PubMed  Google Scholar 

  17. Al-Hawary MM, Francis IR, Chari ST, Fishman EK, Hough DM, Lu DS, Macari M, Megibow AJ, Miller FH, Mortele KJ, Merchant NB, Minter RM, Tamm EP, Sahani DV, Simeone DM (2014) Pancreatic ductal adenocarcinoma radiology reporting template: consensus statement of the society of abdominal radiology and the american pancreatic association. Gastroenterology 146:291–304

    Article  PubMed  Google Scholar 

  18. Volmar KE, Vollmer RT, Jowell PS, Nelson RC, Xie HB (2005) Pancreatic FNA in 1000 cases: a comparison of imaging modalities. Gastrointest Endosc 61:854–861

    Article  PubMed  Google Scholar 

  19. Hewitt MJ, McPhail MJ, Possamai L, Dhar A, Vlavianos P, Monahan KJ (2012) EUS-guided FNA for diagnosis of solid pancreatic neoplasms: a meta-analysis. Gastrointest Endosc 75:319–331

    Article  PubMed  Google Scholar 

  20. Varadhachary GR, Wolff RA, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Abdalla E, Wang H, Staerkel GA, Lee JH, Ross WA, Tamm EP, Bhosale PR, Krishnan S, Das P, Ho L, Xiong H, Abbruzzese JL, Evans DB (2008) Preoperative gemcitabine and cisplatin followed by gemcitabine-based chemoradiation for resectable adenocarcinoma of the pancreatic head. J Clin Oncol 26:3487–3495

    Article  CAS  PubMed  Google Scholar 

  21. Landry J, Catalano PJ, Staley C et al (2010) Randomized phase II study of 36. gemcitabine plus radiotherapy versus gemcitabine, 5-fluorouracil, and cisplatin followed by radiotherapy and 5-fluorouracil for patients with locally advanced, potentially resectable pancreatic adenocarcinoma. J Surg Oncol 101:587–592

    Article  CAS  PubMed  PubMed Central  Google Scholar 

  22. Salvia R, Malleo G, Butturini G, Dal Molin M, Esposito A, Marchegiani G, Paiella S, Malpaga A, Fontana M, Personi B, Bassi C (2013) Perioperative management of patients undergoing pancreatic resection: implementation of a care plan in a tertiary-care center. J Surg Oncol 107:51–57

    Article  PubMed  Google Scholar 

  23. Braga M, Pecorelli N, Ariotti R, Capretti G, Greco M, Balzano G, Castoldi R, Beretta L (2014) Enhanced recovery after surgery pathway in patients undergoing pancreaticoduodenectomy. World J Surg 38:2960–2966

    Article  PubMed  Google Scholar 

  24. Lavu H, Sell NM, Carter TI, Winter JM, Maguire DP, Gratch DM, Berman RA, Feil MG, Grunwald Z, Leiby BE, Pequignot EC, Rosato EL, Yeo CJ (2014) The HYSLAR trial: a prospective randomized controlled trial of the use of a restrictive fluid regimen with 3% hypertonic saline versus lactated ringers in patients undergoing pancreaticoduodenectomy. Ann Surg 260:445–455

    Article  PubMed  Google Scholar 

  25. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW, European Study Group for Pancreatic Cancer (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210

    Article  CAS  PubMed  Google Scholar 

  26. Neoptolemos JP, Stocken DD, Bassi C, Ghaneh P, Cunningham D, Goldstein D, Padbury R, Moore MJ, Gallinger S, Mariette C, Wente MN, Izbicki JR, Friess H, Lerch MM, Dervenis C, Oláh A, Butturini G, Doi R, Lind PA, Smith D, Valle JW, Palmer DH, Buckels JA, Thompson J, McKay CJ, Rawcliffe CL, Büchler MW, European Study Group for Pancreatic Cancer (1073) Adjuvant chemotherapy with fluorouracil plus folinic acid vs gemcitabine following pancreatic cancer resection: a randomized controlled trial. JAMA 304:1073–1081

    Article  Google Scholar 

  27. Liao WC, Chien KL, Lin YL, Wu MS, Lin JT, Wang HP, Tu YK (2013) Adjuvant treatments for resected pancreatic adenocarcinoma: a systematic review and network meta-analysis. Lancet Oncol 14:1095–1103

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Unit of General and Pancreatic Surgery, Department of Surgery and Oncology, The Pancreas Institute, P.Le L.A. Scuro 10, 37134, Verona, Italy

    Claudio Bassi & Marco Ramera

  2. Pancreas Unit, Department of Surgery, San Raffaele Scientific Institute, Milano, Italy

    Giampaolo Balzano

  3. Section of Pancreatic Surgery, Humanitas Research Hospital, Milano, Rozzano, Italy

    Alessandro Zerbi

Authors
  1. Claudio Bassi
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Giampaolo Balzano
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Alessandro Zerbi
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Marco Ramera
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Claudio Bassi.

Ethics declarations

Conflict of interest

The authors declare that they have no conflict of interest.

Research involving human participants and/or animals

This article does not contain any studies with human participants or animals performed by any of the authors.

Informed consent

Performed by any of the authors and than there is not need of any Informed consent Patient signed.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Bassi, C., Balzano, G., Zerbi, A. et al. Pancreatic surgery in Italy. Criteria to identify the hospital units and the tertiary referral centers entitled to perform it. Updates Surg 68, 117–122 (2016). https://doi.org/10.1007/s13304-016-0371-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s13304-016-0371-2

Keywords

Search

Navigation