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Centralization of pancreatic cancer treatment within an integrated healthcare system improves overall survival

Published:September 30, 2021DOI:https://doi.org/10.1016/j.amjsurg.2021.09.036

      Highlights

      • Centralization of pancreatic cancer surgery has been shown to improve outcomes.
      • We centralized surgeries, oncology, gastroenterology, and interventional radiology.
      • Median length of survival improved by 3 months.
      • 25% more patients had >16 lymph nodes removed.
      • 30% of patients received neoadjuvant therapy, from 10% pre-centralization.

      Abstract

      Background

      Higher-volume centers for pancreatic cancer surgeries have been shown to have improved outcomes such as length of stay. We examined how centralization of pancreatic cancer care within a regional integrated healthcare system improves overall survival.

      Methods

      We conducted a retrospective study of 1621 patients treated for pancreatic cancer from February 2010 to December 2018. Care was consolidated into 4 Centers of Excellence (COE) in surgery, medical oncology, and other specialties. Descriptive statistics, bivariate analysis, Chi-square tests, and Kaplan–Meier analysis were performed.

      Results

      Neoadjuvant chemotherapy use rose from 10% to 31% (p < .001). The median overall survival (OS) improved by 3 months after centralization (p < .001), but this did not reach significance on multivariate analysis.

      Conclusions

      Our results suggest that in a large integrated healthcare system, centralization improves overall survival and neoadjuvant therapy utilization for pancreatic cancer patients.

      Keywords

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