TY - JOUR
T1 - Practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer
T2 - A nationwide cohort study
AU - Groen, Jesse V.
AU - Michiels, Nynke
AU - Besselink, Marc G.
AU - Bosscha, Koop
AU - Busch, Olivier R.
AU - van Dam, Ronald
AU - van Eijck, Casper H.J.
AU - Koerkamp, Bas Groot
AU - van der Harst, Erwin
AU - de Hingh, Ignace H.
AU - Karsten, Tom M.
AU - Lips, Daan J.
AU - de Meijer, Vincent E.
AU - Molenaar, Isaac Q.
AU - Nieuwenhuijs, Vincent B.
AU - Roos, Daphne
AU - van Santvoort, Hjalmar C.
AU - Wijsman, Jan H.
AU - Wit, Fennie
AU - Zonderhuis, Babs M.
AU - de Vos-Geelen, Judith
AU - Wasser, Martin N.
AU - Bonsing, Bert A.
AU - Stommel, Martijn W.J.
AU - Mieog, J. Sven D.
AU - Dutch Pancreatic Cancer Group
N1 - Funding Information:
The authors would like to acknowledge Stijn van Roessel (Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, University of Amsterdam, the Netherlands), Mustafa Suker (Department of Surgery, Erasmus Medical Center, Rotterdam, the Netherlands), Lois Damen (Department of Surgery, University Medical Center Utrecht, Utrecht, the Netherlands), Bobby Pranger (Department of Surgery, University of Groningen and University Medical Center Groningen, Groningen), Marjolein Ligthart (Department of Surgery, Maastricht University Medical Center, Maastricht, the Netherlands), Lenka Boyd (Department of Surgery, Cancer Center Amsterdam, Amsterdam University Medical Center, Vrije Universiteit Amsterdam, Amsterdam, the Netherlands), and Michelle de Graaff (Dutch Institute for Clinical Auditing, Scientific Bureau, Leiden, the Netherlands) for providing administrative support.
Publisher Copyright:
© 2023 The Author(s)
PY - 2023/1/1
Y1 - 2023/1/1
N2 - Background: Practice variation exists in venous resection during pancreatoduodenectomy, but little is known about the potential causes and consequences as large studies are lacking. This study explores the potential causes and consequences of practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer in the Netherlands. Methods: This nationwide retrospective cohort study included patients undergoing pancreatoduodenectomy for pancreatic cancer in 18 centers from 2013 through 2017. Results: Among 1,311 patients undergoing pancreatoduodenectomy, 351 (27%) had a venous resection, and the overall median annual center volume of venous resection was 4. No association was found between the center volume of pancreatoduodenectomy and the rate of venous resections, nor between patient and tumor characteristics and the rate of venous resections per center. Female sex, lower body mass index, neoadjuvant therapy, venous involvement, and stenosis on imaging were predictive for venous resection. Adjusted for these factors, 3 centers performed significantly more, and 3 centers performed significantly fewer venous resections than expected. In patients with venous resection, significantly less major morbidity (22% vs 38%) and longer overall survival (median 16 vs 12 months) were observed in centers with an above-median annual volume of venous resections (>4). Conclusion: Patient and tumor characteristics did not explain significant practice variation between centers in the Netherlands in venous resection during pancreatoduodenectomy for pancreatic cancer. The clinical outcomes of venous resection might be related to the volume of the procedure.
AB - Background: Practice variation exists in venous resection during pancreatoduodenectomy, but little is known about the potential causes and consequences as large studies are lacking. This study explores the potential causes and consequences of practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer in the Netherlands. Methods: This nationwide retrospective cohort study included patients undergoing pancreatoduodenectomy for pancreatic cancer in 18 centers from 2013 through 2017. Results: Among 1,311 patients undergoing pancreatoduodenectomy, 351 (27%) had a venous resection, and the overall median annual center volume of venous resection was 4. No association was found between the center volume of pancreatoduodenectomy and the rate of venous resections, nor between patient and tumor characteristics and the rate of venous resections per center. Female sex, lower body mass index, neoadjuvant therapy, venous involvement, and stenosis on imaging were predictive for venous resection. Adjusted for these factors, 3 centers performed significantly more, and 3 centers performed significantly fewer venous resections than expected. In patients with venous resection, significantly less major morbidity (22% vs 38%) and longer overall survival (median 16 vs 12 months) were observed in centers with an above-median annual volume of venous resections (>4). Conclusion: Patient and tumor characteristics did not explain significant practice variation between centers in the Netherlands in venous resection during pancreatoduodenectomy for pancreatic cancer. The clinical outcomes of venous resection might be related to the volume of the procedure.
U2 - 10.1016/j.surg.2023.06.012
DO - 10.1016/j.surg.2023.06.012
M3 - Article
C2 - 37451894
SN - 0039-6060
VL - 174
SP - 924
EP - 933
JO - Surgery
JF - Surgery
IS - 4
ER -