title: Resection rate, hospital procedure volume and survival in pancreatic cancer patients in England: Population-based study, 2005-2009.
abstract: OBJECTIVE
  We assessed the association between population resection rates, hospital procedure volume and death rates in pancreatic cancer patients in England.
  
  
  METHODS
  Patients diagnosed with pancreatic cancer were identified from a linked cancer registration and Hospital Episode Statistics dataset. Cox regression analyses were used to assess all-cause mortality according to resection quintile and hospital volume, adjusting for sex, age, deprivation and comorbidity.
  
  
  RESULTS
  There were 31,973 pancreatic cancer patients studied, 2580 had surgery. Increasing resection rates were associated with lower mortality among all patients (χ(2)(1df) = 176.18, ptrend < 0.001), with an unadjusted hazard ratio (HR) of 0.78 95%CI [0.75 to 0.81] in the highest versus the lowest resection quintile. Adjustment changed the estimate slightly (HR 0.82, 95%CI [0.79 to 0.85], (χ(2)(1df) = 99.44, ptrend < 0.001)). Among patients that underwent surgery, higher procedure volume was associated with lower mortality (HR = 0.88 95%CI [0.75-1.03] in hospitals carrying out 30+ versus <15 operations a year, shared frailty model, χ(2)(1df) = 1.82, ptrend = 0.177).
  
  
  CONCLUSIONS
  Higher population resection rates were associated with lower mortality. The association with hospital procedure volume was less clear possibly due to small number of patients who underwent surgery. Nevertheless these results suggest survival is higher in hospitals that carry out a greater number of operations a year, particularly those doing 30+ operations, supporting the benefit of centralising perioperative expertise in specialist centres. Ensuring people are increasingly diagnosed when they are suitable candidates for surgery, and have access to these specialist centres may lead to an increase in the proportion of patients that undergo surgical resection which could plausibly increase survival of pancreatic cancer patients.
authors.affiliation: Public Health England, National Cancer Intelligence Network, London, UK. Electronic address: victoria.coupland@phe.gov.uk.
authors.forename: V H
authors.initials: VH
authors.lastname: Coupland
authors.affiliation: Public Health England, National Cancer Intelligence Network, London, UK.
authors.forename: J
authors.initials: J
authors.lastname: Konfortion
authors.affiliation: Public Health England, National Cancer Intelligence Network, London, UK.
authors.forename: R H
authors.initials: RH
authors.lastname: Jack
authors.affiliation: The Royal Marsden NHS Foundation Trust, Department of Surgery, London, UK.
authors.forename: W
authors.initials: W
authors.lastname: Allum
authors.affiliation: Centre for Tumour Biology, Barts Cancer Institute - a Cancer Research UK Centre of Excellence, Queen Mary University of London, London EC1M 6BQ, UK.
authors.forename: H M
authors.initials: HM
authors.lastname: Kocher
authors.affiliation: Public Health England, National Cancer Intelligence Network, London, UK.
authors.forename: S P
authors.initials: SP
authors.lastname: Riaz
authors.affiliation: Public Health England, National Cancer Intelligence Network, London, UK; King's College London, Division of Cancer Studies, London, UK.
authors.forename: M
authors.initials: M
authors.lastname: Lüchtenborg
authors.affiliation: King's College London, Division of Cancer Studies, London, UK.
authors.forename: H
authors.initials: H
authors.lastname: Møller
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D015897:Comorbidity; D004739:England / Q000453:epidemiology; D005260:Female; D061847:Hospitals, High-Volume / Q000706:statistics & numerical data*; D061846:Hospitals, Low-Volume / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000601:surgery*; D012737:Sex Factors; D012959:Socioeconomic Factors; D015996:Survival Rate
keywords: England; Hospital procedure volume; Pancreatic cancer; Population resection rate; Survival