Outcome of surgical treatment of pancreatic, peri-ampullary and ampullary cancer diagnosed in the south of The Netherlands: a cancer registry based study.
OBJECTIVE
To gain insight into the quality of pancreatic cancer surgery in 10 low-volume (median sized) hospitals, each serving 150,000-250,000 people, in the Comprehensive Cancer Centre South (CCCS) area and of referred patients to academic centres to determine the need for further regionalization.


METHODS
The population-based Eindhoven Cancer Registry was used to select all patients in the CCCS area with pancreatic, peri-ampullary and ampullary cancer diagnosed between January 1, 1995 and April 30, 2000 (N = 1130). Of those, 124 patients (11%) underwent surgical resection (of which 40 were treated in university hospitals outside the region).


RESULTS
For all pancreatic carcinoma resections, the 3-month survival rate was 82%, varying from 95% for referred patients to 76% for patients treated within the region (p = 0.014). One- and two-year survival rates showed no difference between both groups (p = 0.36 and p = 0.55, respectively). Surgically treated patients who were referred to university hospitals outside the CCCS area were younger, more often male, more often diagnosed with pTNM stage III, exhibited less comorbidity and had a higher socio-economic status than patients surgically treated within the region.


CONCLUSIONS
Although the results are based on small numbers and patient selection probably influenced these outcomes, these data seem to support further hospital specialisation, to which the surgeons of the CCCS area have committed themselves.
van Oost
F J
FJ
Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands.
Luiten
E J T
EJ
van de Poll-Franse
L V
LV
Coebergh
J W W
JW
van den Eijnden-van Raaij
A J M
AJ
D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery*; D002277:Carcinoma / Q000601:surgery*; D002391:Catchment Area, Health; D003138:Common Bile Duct Neoplasms / Q000601:surgery*; D005260:Female; D006769:Hospitals, General; D006785:Hospitals, University; D006801:Humans; D008297:Male; D008875:Middle Aged; D020380:Needs Assessment; D009367:Neoplasm Staging; D009426:Netherlands; D010190:Pancreatic Neoplasms / Q000601:surgery*; D011159:Population Surveillance; D012017:Referral and Consultation; D012042:Registries; D012737:Sex Factors; D012923:Social Class; D015996:Survival Rate; D016896:Treatment Outcome