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Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers.

Abstract：

OBJECTIVE:This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers. BACKGROUND:Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoretical advantages for undergoing surgery locally exist. METHODS:The 1998 to 2012 National Cancer Data Base was queried for T1-3N0-1M0 pancreatic adenocarcinoma patients who underwent PD. Travel distances to treatment centers were calculated. Overlaying the upper and lower quartiles of travel distance with institutional volume established short travel/low-volume (ST/LV) and long travel/high-volume (LT/HV) cohorts. Overall survival was evaluated. RESULTS:Of 7086 patients, 773 ST/LV patients traveled ≤6.3 (median 3.2) miles to centers performing ≤3.3 PDs yearly, and 758 LT/HV patients traveled ≥45 (median 97.3) miles to centers performing ≥16 PDs yearly. LT/HV patients had higher stage disease (P < 0.001), but lower margin positivity (20.5% vs 25.9%, P = 0.01) and improved lymphadenectomy (16 vs 11 nodes, P < 0.01). Moreover, LT/HV patients had shorter hospitalizations (9 vs 12 days, P < 0.01) and lower 30-day mortality (2.0% vs 6.3%, P < 0.01) with similar 30-day readmission rates (10.1% vs 9.8%, P = 0.83). Despite more advanced disease, LT/HV patients had superior unadjusted survival (20.3 vs 15.7 months). After adjustment, travel to a high-volume center remained associated with reduced long-term mortality (hazard ratio 0.75, P < 0.01). CONCLUSIONS:Despite an increased travel burden, patients treated at high-volume centers had improved perioperative outcomes, short-term mortality, and overall survival. These data support ongoing efforts to centralize care for patients undergoing PD.

journal_name

Ann Surg

journal_title

Annals of surgery

authors

Lidsky ME,Sun Z,Nussbaum DP,Adam MA,Speicher PJ,Blazer DG 3rd

doi

10.1097/SLA.0000000000001924

subject

Has Abstract

pub_date

2017-08-01 00:00:00

pages

333-338

issue

eissn

0003-4932

issn

1528-1140

journal_volume

266

pub_type

杂志文章

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Going the Extra Mile: Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers.