Surgical outcomes following pancreatic resection at a low-volume community hospital: do all patients need to be sent to a regional cancer center?

BACKGROUND: The only curative option for patients with pancreatic cancer is surgical resection. The potential for significant morbidity and mortality following these procedures along with short-term survival benefit has called into question the role of surgery in this disease. Several recent reports have shown that morbidity, mortality, and survival can be improved if these pancreatic resections are performed at centers where large volumes of cases are done annually.
METHODS: A retrospective review of the tumor registry from 1994 to 2003 identified 242 cases of pancreatic cancer diagnosed and/or treated at our institution. During this period, 31/242 (13%) patients underwent surgical resection. Patients' charts were reviewed for diagnosis, stage of tumor, presenting symptoms, surgery, length of stay, and survival. Morbidity and mortality rates were calculated for all patients.
RESULTS: Thirty-one resections were performed in 16 males and 15 females. The median age at presentation was 69 years. The most common presenting symptom was painless jaundice. A pancreaticoduodenectomy was the most common procedure (n = 24), while 7 distal pancreatectomies were also performed. Eight surgeons performed the 31 resections with one surgeon performing 12 of the cases. The median length of stay was 16 days. Complications arose in 15/31 (48%) patients. There was no 30-day surgical or in-hospital mortality.
CONCLUSIONS: Major pancreatic surgery can be performed safely at community hospitals. It is imperative that each hospital is responsible for providing morbidity and mortality figures related to pancreatic procedures performed at their institution. In this changing climate of reimbursement and pay for performance, institutions that do not do this may be required to send these cases to regional centers.