title: Improving outcome for patients with pancreatic cancer through centralization.
abstract: BACKGROUND
  High-volume institutions are associated with improved clinical outcomes for pancreatic cancer. This study investigated the impact of centralizing pancreatic cancer surgery in the south of the Netherlands.
  
  
  METHODS
  All patients diagnosed in the Eindhoven Cancer Registry area in 1995-2000 (precentralization) and 2005-2008 (implementation of centralization agreements) with primary cancer of the pancreatic head, extrahepatic bile ducts, ampulla of Vater or duodenum were included. Resection rates, in-hospital mortality, 2-year survival and changes in treatment patterns were analysed. Multivariable regression analyses were used to identify independent risk factors for death.
  
  
  RESULTS
  Some 2129 patients were identified. Resection rates increased from 19·0 to 30·0 per cent (P < 0·001). The number of hospitals performing resections decreased from eight to three, and the annual number of resections per hospital increased from two to 16. The in-hospital mortality rate dropped from 24·4 to 3·6 per cent (P < 0·001) and was zero in 2008. The 2-year survival rate after surgery increased from 38·1 to 49·4 per cent (P = 0·001), and the rate irrespective of treatment increased from 10·3 to 16·0 per cent (P < 0·001). There was no improvement in 2-year survival in non-operated patients. After adjustment for relevant patient and tumour factors, those undergoing surgery more recently had a lower risk of death (hazard ratio 0·70, 95 per cent confidence interval 0·51 to 0·97). Changes in surgical patterns seemed largely to explain the improvements.
  
  
  CONCLUSIONS
  High-quality care can be achieved in regional hospitals through collaboration. Centralization should no longer be regarded as a threat by general hospitals but as a chance to improve outcomes in pancreatic cancer.
authors: Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands. v.lemmens@ikz.nl
authors: V E P P
authors: VE
authors: Lemmens
authors: K
authors: K
authors: Bosscha
authors: G
authors: G
authors: van der Schelling
authors: S
authors: S
authors: Brenninkmeijer
authors: J W W
authors: JW
authors: Coebergh
authors: I H J T
authors: IH
authors: de Hingh
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater / Q000601:surgery; D001650:Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery; D017734:Bile Ducts, Extrahepatic; D002173:Cancer Care Facilities / Q000458:organization & administration*; D002497:Centralized Hospital Services / Q000458:organization & administration; D004379:Duodenal Neoplasms / Q000401:mortality / Q000601:surgery; D005260:Female; D006276:Health Facility Size / Q000458:organization & administration*; D006801:Humans; D007373:Interinstitutional Relations; D008297:Male; D008875:Middle Aged; D009426:Netherlands / Q000453:epidemiology; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011787:Quality of Health Care; D012042:Registries; D016019:Survival Analysis; D016896:Treatment Outcome