O. Moaven1, J. M. Richman1, S. Reddy1, T. M. Wang1, C. M. Contreras1 1University Of Alabama At Birmingham,Department Of Surgery,Birmingham, AL, USA
Introduction: Surgical resection is the only intervention known to significantly affect outcomes in patients with pancreatic cancer. It is very important to identify the factors that can improve the surgical outcomes in pancreatic cancer. In this nationwide retrospective study we compared the outcomes of tumor resection in academic vs. nonacademic centers.
Methods: We analyzed American College of Surgeons National Cancer Database (NCDB) and included patients with pancreatic adenocarcinoma who have undergone pancreatic resection between 1998 and 2012. Unadjusted chi-square and t-tests and multivariate generalized additive models were used to compare the differences between patient characteristics and outcomes of the patients treated in academic centers vs. nonacademic centers.
Results: We identified 62858 patients with surgical resection of their pancreatic cancer. While 34245 (54.5%) had their resection at an academic (A) center versus 28613 (45.5%) at non-academic (nonA) centers (p<0.001), these proportions varied significantly over time. Before 2007, 52.2% were in academic centers vs. 47.8% in nonacademic; in 2007 and afterwards, the proportions were, respectively, 56.7% and 43.3% (p<0.001). Overall, Patients traveled further to academic centers (mean miles: A: 75.6, nonA: 26.6, p<0.001), and waited longer for resection (mean days: A 29.2, nonA 20.9, p<0.001). Academic centers also had higher volumes with a mean of 30.1 resections per year vs. 6.9 for nonacademic (p<0.001), examined more lymph nodes per resection with an average of 13.5 vs. 11.0 (p<0.001) and were more likely to achieve negative margins 76.7 vs. 72.5% (p<0.001). In unadjusted analyses there were several significant differences when comparing outcomes between Academic and Nonacademic centers including: overall survival (A vs. NonA: HR 0.83, 95%CI:0.81-0.84, p<0.001), 30-day post-operative mortality (A vs. NonA: OR 0.64, 95%CI:0.61-0.68, p<0.001), 90-day post-operative mortality (A vs. NonA: OR 0.68, 95%CI:0.65-0.72, p<0.001), and 30-day readmission (A vs. NonA: OR 0.94, 95%CI:0.90-0.99, p=0.03). These differences remained significant in models adjusted for patient, tumor, and operative characteristics but were not significant after surgical volume of the center was added to the adjusted model.
Conclusion: Patients with pancreatic cancer who undergo surgical resection in academic centers have better outcomes likely related to higher annual volume. Centralizing tumor resection in higher volume academic centers is an essential step to improve survival of patients with resectable pancreatic cancer.