Improved Survival with Delayed Surgery at High-Volume Centers Versus Early Surgery at Low-Volume Centers for Pancreatic Cancer.
TL;DR
Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC, and these findings assuage concerns regarding the potential longer wait times for surgery associated with centralization of surgical care for PDAC.
OpenAlex 토픽 ·
Pancreatic and Hepatic Oncology Research
Pancreatitis Pathology and Treatment
Cholangiocarcinoma and Gallbladder Cancer Studies
Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC, and these findings assuage concerns regarding the pot
- p-value P < 0.001
- 95% CI 0.77-0.85
APA
Sara Sakowitz, Mampei Yamashita, et al. (2026). Improved Survival with Delayed Surgery at High-Volume Centers Versus Early Surgery at Low-Volume Centers for Pancreatic Cancer.. Annals of surgical oncology, 33(5), 4049-4060. https://doi.org/10.1245/s10434-025-19052-4
MLA
Sara Sakowitz, et al.. "Improved Survival with Delayed Surgery at High-Volume Centers Versus Early Surgery at Low-Volume Centers for Pancreatic Cancer.." Annals of surgical oncology, vol. 33, no. 5, 2026, pp. 4049-4060.
PMID
41538116
Abstract
[BACKGROUND] Although the relationship between higher surgical volume and improved outcomes for pancreatic operations is well established, centralizing care to high-volume centers (HVC) may prolong the interval from diagnosis to surgery. This study sought to compare outcomes of patients who had longer wait times for upfront surgery for pancreatic cancer (PDAC) at HVCs with those of patients who underwent earlier surgery at low-volume centers (LVCs).
[METHODS] Patients undergoing upfront pancreatic surgery for T1-3N0-2M0 PDAC were identified from the 2004-2023 National Cancer Database. High-volume centers were defined using Leapfrog criteria as centers performing ≥ 20 pancreatic resections/year, with others defined as LVCs. Patients who waited more than 28 days for resection at HVCs were classified as "long wait/high volume," whereas those who underwent surgery in ≤ 14 days at LVCs were classified as "short wait/low volume."
[RESULTS] Among 15,310 patients meeting the inclusion criteria, 9598 (63%) were short wait/low volume and 5712 (37%) were long wait/high volume. In unadjusted analysis, long wait/high volume demonstrated superior 5-year survival (23% vs. 19%, P < 0.001, log-rank). After comprehensive risk adjustment, waiting for surgery at an HVC remained associated with reduced mortality hazard during 5 years of follow-up evaluation (hazard ratio [HR], 0.81; 95% CI, 0.77-0.85; P < 0.001). Considering acute endpoints, the long-wait/high-volume group demonstrated greater likelihood of complete (R0) resection and reduced 30-day mortality, but higher risk of nodal disease and upstaging at resection.
[CONCLUSION] Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC. These findings assuage concerns regarding the potential longer wait times for surgery associated with centralization of surgical care for PDAC.
[METHODS] Patients undergoing upfront pancreatic surgery for T1-3N0-2M0 PDAC were identified from the 2004-2023 National Cancer Database. High-volume centers were defined using Leapfrog criteria as centers performing ≥ 20 pancreatic resections/year, with others defined as LVCs. Patients who waited more than 28 days for resection at HVCs were classified as "long wait/high volume," whereas those who underwent surgery in ≤ 14 days at LVCs were classified as "short wait/low volume."
[RESULTS] Among 15,310 patients meeting the inclusion criteria, 9598 (63%) were short wait/low volume and 5712 (37%) were long wait/high volume. In unadjusted analysis, long wait/high volume demonstrated superior 5-year survival (23% vs. 19%, P < 0.001, log-rank). After comprehensive risk adjustment, waiting for surgery at an HVC remained associated with reduced mortality hazard during 5 years of follow-up evaluation (hazard ratio [HR], 0.81; 95% CI, 0.77-0.85; P < 0.001). Considering acute endpoints, the long-wait/high-volume group demonstrated greater likelihood of complete (R0) resection and reduced 30-day mortality, but higher risk of nodal disease and upstaging at resection.
[CONCLUSION] Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC. These findings assuage concerns regarding the potential longer wait times for surgery associated with centralization of surgical care for PDAC.
MeSH Terms
Humans; Pancreatic Neoplasms; Hospitals, High-Volume; Female; Male; Hospitals, Low-Volume; Aged; Survival Rate; Pancreatectomy; Middle Aged; Time-to-Treatment; Follow-Up Studies; Prognosis
같은 제1저자의 인용 많은 논문 (5)
- National race-based disparities in referral to Commission on Cancer centers for lung cancer resection.
- ASO Visual Abstract: Improved Survival with Delayed Surgery at High-Volume Centers versus Early Surgery at Low-Volume Centers for Pancreatic Cancer.
- Stereotactic Body Radiation Therapy Utilization Trends for Stage I Non-Small Cell Lung Cancer.
- Impact of Psychosocial Risk Factors on Acute Clinical Outcomes Following Colectomy: A National Perspective.
- Outcomes Following Colectomy at For-Profit Hospitals: A National Analysis.