title: Hospital volume, margin status, and long-term survival after pancreaticoduodenectomy for pancreatic adenocarcinoma.
abstract: An association between hospital surgical volume and short- and long-term outcomes after pancreatic surgery has been demonstrated. Identification of specific factors contributing to this relationship is difficult. In this study, the authors evaluated if margin status can be identified  as a measure of surgical quality, affecting overall survival, as a function of hospital pancreaticoduodenectomy volume. A systematic review of the literature was performed. Two models for analysis were created, dividing the 18 studies identified into quartiles and two quantiles based on the  average annual hospital pancreatectomy volume. Regression modeling and analysis of variance were used to find an association between hospital volume, margin status, and survival. Increasing hospital volume was associated with a significantly increased negative margin status rate: 55 per cent  for low-volume, 72 per cent for medium-volume, 74.3 per cent for high-volume, and 75.7 per cent for very high-volume centers (P = 0.008). The negative margin status rates were 64 per cent and 75.1 per cent for volume centers with less and more than 12 pancreaticoduodenectomies/year,  respectively (P = 0.04). Low-volume centers negatively affected both margin positive resection and 5-year survival rates, compared with high-volume centers. Margin status rate after pancreaticoduodenectomy could, therefore, be considered a measure of quality for selection of hospitals  dedicated to pancreatic surgery.
authors.affiliation: Department of Hepato-Biliary and Pancreatic Surgery, Sant'Andrea Hospital, Faculty of Medicine and Psychology University of Rome La Sapienza, Rome, Italy. marco.latorre@uniroma1.it
authors.forename: Marco
authors.initials: M
authors.lastname: La Torre
authors.forename: Giuseppe
authors.initials: G
authors.lastname: Nigri
authors.forename: Linda
authors.initials: L
authors.lastname: Ferrari
authors.forename: Giulia
authors.initials: G
authors.lastname: Cosenza
authors.forename: Matteo
authors.initials: M
authors.lastname: Ravaioli
authors.forename: Giovanni
authors.initials: G
authors.lastname: Ramacciato
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011184:Postoperative Period; D015996:Survival Rate / Q000639:trends; D013997:Time Factors; D014481:United States / Q000453:epidemiology