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National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery

  • Healthcare Policy and Outcomes
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Surgical margin involvement is an important outcome after pancreatic cancer surgery; however, variation in pathologic review practices may limit its use as a quality indicator. Our objectives were to assess variation in hospital performance and the reliability of margin involvement after pancreatic cancer surgery.

Methods

From the National Cancer Data Base, patients who underwent pancreatic resection for stage I to III adenocarcinoma were identified. Risk-adjusted surgical margin involvement was evaluated using hierarchical regression methods, and variation in hospital performance and reliability was determined.

Results

From 1,002 hospitals, 14,889 patients underwent pancreatic resection for adenocarcinoma, and 3,573 (24.0 %) had an involved surgical margin (R1 22.8 %; R2 1.2 %). The strongest predictors associated with margin involvement were T stage [T3: odds ratio (OR) 2.08, 95 % confidence interval (CI) 1.68–2.59; T4: OR 7.26, 95 % CI 5.50–9.60; vs. T1] and tumor size (2–3.9 cm: OR 1.66, 95 % CI 1.39–1.98, ≥4 cm: OR 2.28, 95 % CI 1.90–2.74; vs. <2 cm). Factors associated with a decreased likelihood of margin involvement were the use of neoadjuvant therapy and hospital type (academic and National Cancer Institute-designated comprehensive cancer centers vs. community). At the hospital level, the mean risk-adjusted surgical margin involvement rate was 25.9 % and ranged 10.1 to 50.5 %. Twenty-one (2.1 %) hospitals had lower-than-expected and 17 (1.7 %) had higher-than-expected margin involvement. A minimum acceptable reliability of 0.4 was met after 13 cases and was achieved by 249 hospitals that performed 79 % of pancreatic resections assessed.

Conclusions

Despite differences in pathologic evaluation practices, hospitals can be feasibly and reliably provided comparative data on surgical margin status after resection for pancreatic cancer.

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Acknowledgment

RPM is supported by the American College of Surgeons Clinical Scholars in Residence Program, the Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, and the American Cancer Society-Illinois Division Cancer Control and Population Science Grant.

Disclosure

The authors declare no conflict of interest.

Author information

Authors and Affiliations

  1. Division of Research and Optimal Patient Care, American College of Surgeons, Chicago, IL, USA

    Ryan P. Merkow MD, MS, Karl Y. Bilimoria MD, MS, David P. Winchester MD & Clifford Y. Ko MD, MS, MSHS

  2. Surgical Outcomes and Quality Improvement Center, Department of Surgery, Northwestern Institute for Comparative Effectiveness Research (NICER) in Oncology, Feinberg School of Medicine, Northwestern University, Chicago, IL, USA

    Ryan P. Merkow MD, MS, Karl Y. Bilimoria MD, MS & David J. Bentrem MD, MS

  3. Department of Surgery, Pritzker School of Medicine, University of Chicago, Chicago, IL, USA

    Ryan P. Merkow MD, MS & Mitchell C. Posner MD

  4. Department of Surgery, Jesse Brown Veteran Affairs Medical Center, Chicago, IL, USA

    David J. Bentrem MD, MS

  5. Department of Surgery, Temple University School of Medicine, Philadelphia, PA, USA

    Henry A. Pitt MD

  6. Department of Surgery, David Geffen School of Medicine, University of California Los Angeles, Los Angeles, CA, USA

    Clifford Y. Ko MD, MS, MSHS

  7. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Timothy M. Pawlik MD, MPH, PhD

Authors
  1. Ryan P. Merkow MD, MS
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  2. Karl Y. Bilimoria MD, MS
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  3. David J. Bentrem MD, MS
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  7. Clifford Y. Ko MD, MS, MSHS
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Correspondence to Ryan P. Merkow MD, MS.

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Merkow, R.P., Bilimoria, K.Y., Bentrem, D.J. et al. National Assessment of Margin Status as a Quality Indicator after Pancreatic Cancer Surgery. Ann Surg Oncol 21, 1067–1074 (2014). https://doi.org/10.1245/s10434-013-3338-2

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  • DOI: https://doi.org/10.1245/s10434-013-3338-2

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