Standardization of surgical care in a high-volume center improves survival in resected pancreatic head cancer.
BACKGROUND
Durable clinical gains in surgical care are frequently reliant on well-developed standardization of practices. We hypothesized that the standardization of surgical management would result in improved long-term survival in pancreatic cancer.


METHODS
Seventy-seven consecutive, eligible patients representing all patients who underwent pancreaticoduodenectomy and received comprehensive, long-term postoperative care at the University of Florida were analyzed. Patients were divided into prestandardization and poststandardization groups based on the implementation of a pancreatic surgery partnership, or standardization program.


RESULTS
Standardization resulted in a reduction in median length of stay (10 vs 12 days; P = .032), as well as significant gains in disease-free survival (17 vs 11 months; P = .017) and overall survival (OS; 26 vs 16 months; P = .004). The improvement in overall survival remained significant on multivariate analysis (hazard ratio = .46, P = .005).


CONCLUSIONS
Standardization of surgical management of pancreatic cancer was associated with significant gains in long-term survival. These results suggest strongly that management of pancreatic head adenocarcinoma be standardized likely by regionalization of care at high performing oncologic surgery programs.
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA.
Daniel
D
Delitto
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA.
Brian S
BS
Black
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA.
Holly B
HB
Cunningham
Department of Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, USA.
Sarunas
S
Sliesoraitis
Department of Biostatistics & Children's Oncology Group, College of Public Health and Health Professions, University of Florida Health Science Center, Gainesville, FL 32610, USA.
Xiaomin
X
Lu
Department of Pathology, College of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, USA.
Chen
C
Liu
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA; North Florida/South Georgia Veterans Health System, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA.
George A
GA
Sarosi
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA; North Florida/South Georgia Veterans Health System, Department of Surgery, University of Florida College of Medicine, Gainesville, FL 32610, USA.
Ryan M
RM
Thomas
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA.
Jose G
JG
Trevino
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA.
Steven J
SJ
Hughes
Department of Medicine, College of Medicine, University of Florida Health Science Center, Gainesville, FL 32610, USA.
Thomas J
TJ
George
Department of Surgery, College of Medicine, University of Florida Health Science Center, P.O. Box 100286, Gainesville, FL 32610, USA. Electronic address: kevin.behrns@surgery.ufl.edu.
Kevin E
KE
Behrns
D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D005260:Female; D006761:Hospitals / Q000706:statistics & numerical data*; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000592:standards* / Q000706:statistics & numerical data; D012189:Retrospective Studies; D016019:Survival Analysis
Centralization; Pancreatic cancer; Pancreatic surgery; Standardization