Resection for pancreatic cancer in the new millennium

被引:39
作者
Andrén-Sandberg, Å
Neoptolemos, JP
机构
[1] Univ Liverpool, Royal Liverpool Univ Hosp, Dept Surg, Liverpool L69 3GA, Merseyside, England
[2] Haukeland Hosp, Dept Surg, N-5021 Bergen, Norway
关键词
complications; hospital costs; morbidity; mortality; pancreatic cancer; resection; volume; Whipple's operation;
D O I
10.1159/000064710
中图分类号
R57 [消化系及腹部疾病];
学科分类号
摘要
Background and Aim of the Study: Complications of pancreatic resections are dangerous and costly. A literature review was therefore done to investigate the evidence for improving the results by regionalizing this demanding surgery. Results: Studies from four countries (USA, UK, the Netherlands and Finland) with advanced health care systems have shown a significant inverse correlation between case volume for pancreatic cancer resection and post-operative mortality. Further analysis reveals lower complications, reduced hospital stay, reduced hospital costs and improved survival of patients treated in high-volume hospitals. The relationship volume and outcome is with institutional volume rather than single surgeon caseload. The evidence therefore strongly supports the regionalization of pancreatic cancer surgery into large specialized multi-disciplinary units. In the UK, the National Health Service Executive has instructed Regional Health Authorities to concentrate pancreatic cancer surgery into designated Regional Centres ideally with catchment populations of 2-4 million. There is now considerable pressure to adopt a similar policy in all countries with advanced health care systems. Conclusion: There is today enough evidence to advocate the regionalization of pancreatic cancer resections. (C) Copyright 2002 S. Karger AG, Basel and IAP.
引用
收藏
页码:431 / 439
页数:9
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