Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience
Background The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center. Methods All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at K...
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| Veröffentlicht in: | Annals of surgical oncology 2021-03, Vol.28 (3), p.1543-1551 |
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| container_title | Annals of surgical oncology |
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| creator | Stoop, Thomas F. Ateeb, Zeeshan Ghorbani, Poya Scholten, Lianne Arnelo, Urban Besselink, Marc G. Del Chiaro, Marco |
| description | Background
The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center.
Methods
All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year.
Results
Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 (
p
20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521;
p |
| doi_str_mv | 10.1245/s10434-020-08957-x |
| format | Article |
| fullrecord | <record><control><sourceid>proquest_swepu</sourceid><recordid>TN_cdi_swepub_primary_oai_swepub_ki_se_469146</recordid><sourceformat>XML</sourceformat><sourcesystem>PC</sourcesystem><sourcerecordid>2431816310</sourcerecordid><originalsourceid>FETCH-LOGICAL-c501t-3979094f59d822777aa0fe58ded128c2502a043c65c74545a2e985c2afe404883</originalsourceid><addsrcrecordid>eNp9kl1PFDEUhhujEUT_gBdmEm-8qfT7w7vNikKCgUTktimdM-vgzHRtp3H59xZ3gcQErtqcPu97etoXobeUfKRMyMNMieACE0YwMVZqvHmG9qmsJaEMfV73RBlsmZJ76FXO14RQzYl8ifY404pypvbRt-8lrfrgh-aszCGOkJtFN0NqLuJci-d-Cgn8DGGO482nZtEc96uf-DIOZYRmCdMterRZQ-phCvAavej8kOHNbj1AP74cXSyP8enZ15Pl4hQHSeiMudWWWNFJ2xrGtNbekw6kaaGlzAQmCfN1tKBk0EIK6RlYIwPzHQgijOEHCG998x9Ylyu3Tv3o042Lvne70q-6AyeUpUJV3j7Kr1NsH0R3QioE16J2fbLX5_5y4WJauTIWR7UQmlX-w5avxr8L5NmNfQ4wDH6CWLJjglNDFaekou__Q69jSVN9uUpZYhTV1laKbamQYs4JuvsrUOJug-C2QXA1CO5fENymit7trMvVCO295O7nK8B3Y9WjaQXpofcTtn8B9Ga-Bw</addsrcrecordid><sourcetype>Open Access Repository</sourcetype><iscdi>true</iscdi><recordtype>article</recordtype><pqid>2490861799</pqid></control><display><type>article</type><title>Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience</title><source>MEDLINE</source><source>SpringerLink Journals - AutoHoldings</source><creator>Stoop, Thomas F. ; Ateeb, Zeeshan ; Ghorbani, Poya ; Scholten, Lianne ; Arnelo, Urban ; Besselink, Marc G. ; Del Chiaro, Marco</creator><creatorcontrib>Stoop, Thomas F. ; Ateeb, Zeeshan ; Ghorbani, Poya ; Scholten, Lianne ; Arnelo, Urban ; Besselink, Marc G. ; Del Chiaro, Marco</creatorcontrib><description>Background
The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center.
Methods
All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year.
Results
Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 (
p
< 0.001). Over time, TP was more often performed to achieve radicality (
n
= 11, 17.5% to
n
= 31, 37.8%;
p
= 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521;
p
< 0.001). In the high-volume years (2016–2017), major morbidity (
n
= 31, 49.2% to
n
= 19, 23.2%;
p
= 0.001) and relaparotomy rate (
n
= 13, 20.6% to
n
= 5, 6.1%;
p
= 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (
n
= 22, 57.9% to
n
= 12, 25.0%;
p
= 0.002) and in-hospital mortality (
n
= 3, 7.9% to
n
= 0, 0%;
p
= 0.082).
Conclusions
In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.</description><identifier>ISSN: 1068-9265</identifier><identifier>ISSN: 1534-4681</identifier><identifier>EISSN: 1534-4681</identifier><identifier>DOI: 10.1245/s10434-020-08957-x</identifier><identifier>PMID: 32761326</identifier><language>eng</language><publisher>Cham: Springer International Publishing</publisher><subject>Adolescent ; Adult ; Elective Surgical Procedures ; Hospital Mortality ; Humans ; Medicin och hälsovetenskap ; Medicine ; Medicine & Public Health ; Morbidity ; Mortality ; Oncology ; Pancreatectomy ; Pancreatic Neoplasms - surgery ; Pancreatic Tumors ; Retrospective Studies ; Surgery ; Surgical Oncology ; Surgical outcomes ; Treatment Outcome</subject><ispartof>Annals of surgical oncology, 2021-03, Vol.28 (3), p.1543-1551</ispartof><rights>Society of Surgical Oncology 2020</rights><rights>Society of Surgical Oncology 2020.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c501t-3979094f59d822777aa0fe58ded128c2502a043c65c74545a2e985c2afe404883</citedby><cites>FETCH-LOGICAL-c501t-3979094f59d822777aa0fe58ded128c2502a043c65c74545a2e985c2afe404883</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><linktopdf>$$Uhttps://link.springer.com/content/pdf/10.1245/s10434-020-08957-x$$EPDF$$P50$$Gspringer$$H</linktopdf><linktohtml>$$Uhttps://link.springer.com/10.1245/s10434-020-08957-x$$EHTML$$P50$$Gspringer$$H</linktohtml><link.rule.ids>230,314,780,784,885,27924,27925,41488,42557,51319</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/32761326$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink><backlink>$$Uhttps://urn.kb.se/resolve?urn=urn:nbn:se:umu:diva-174472$$DView record from Swedish Publication Index$$Hfree_for_read</backlink><backlink>$$Uhttp://kipublications.ki.se/Default.aspx?queryparsed=id:144374985$$DView record from Swedish Publication Index$$Hfree_for_read</backlink></links><search><creatorcontrib>Stoop, Thomas F.</creatorcontrib><creatorcontrib>Ateeb, Zeeshan</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><creatorcontrib>Scholten, Lianne</creatorcontrib><creatorcontrib>Arnelo, Urban</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Del Chiaro, Marco</creatorcontrib><title>Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience</title><title>Annals of surgical oncology</title><addtitle>Ann Surg Oncol</addtitle><addtitle>Ann Surg Oncol</addtitle><description>Background
The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center.
Methods
All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year.
Results
Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 (
p
< 0.001). Over time, TP was more often performed to achieve radicality (
n
= 11, 17.5% to
n
= 31, 37.8%;
p
= 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521;
p
< 0.001). In the high-volume years (2016–2017), major morbidity (
n
= 31, 49.2% to
n
= 19, 23.2%;
p
= 0.001) and relaparotomy rate (
n
= 13, 20.6% to
n
= 5, 6.1%;
p
= 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (
n
= 22, 57.9% to
n
= 12, 25.0%;
p
= 0.002) and in-hospital mortality (
n
= 3, 7.9% to
n
= 0, 0%;
p
= 0.082).
Conclusions
In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.</description><subject>Adolescent</subject><subject>Adult</subject><subject>Elective Surgical Procedures</subject><subject>Hospital Mortality</subject><subject>Humans</subject><subject>Medicin och hälsovetenskap</subject><subject>Medicine</subject><subject>Medicine & Public Health</subject><subject>Morbidity</subject><subject>Mortality</subject><subject>Oncology</subject><subject>Pancreatectomy</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreatic Tumors</subject><subject>Retrospective Studies</subject><subject>Surgery</subject><subject>Surgical Oncology</subject><subject>Surgical outcomes</subject><subject>Treatment Outcome</subject><issn>1068-9265</issn><issn>1534-4681</issn><issn>1534-4681</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2021</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><sourceid>ABUWG</sourceid><sourceid>AFKRA</sourceid><sourceid>BENPR</sourceid><sourceid>CCPQU</sourceid><recordid>eNp9kl1PFDEUhhujEUT_gBdmEm-8qfT7w7vNikKCgUTktimdM-vgzHRtp3H59xZ3gcQErtqcPu97etoXobeUfKRMyMNMieACE0YwMVZqvHmG9qmsJaEMfV73RBlsmZJ76FXO14RQzYl8ifY404pypvbRt-8lrfrgh-aszCGOkJtFN0NqLuJci-d-Cgn8DGGO482nZtEc96uf-DIOZYRmCdMterRZQ-phCvAavej8kOHNbj1AP74cXSyP8enZ15Pl4hQHSeiMudWWWNFJ2xrGtNbekw6kaaGlzAQmCfN1tKBk0EIK6RlYIwPzHQgijOEHCG998x9Ylyu3Tv3o042Lvne70q-6AyeUpUJV3j7Kr1NsH0R3QioE16J2fbLX5_5y4WJauTIWR7UQmlX-w5avxr8L5NmNfQ4wDH6CWLJjglNDFaekou__Q69jSVN9uUpZYhTV1laKbamQYs4JuvsrUOJug-C2QXA1CO5fENymit7trMvVCO295O7nK8B3Y9WjaQXpofcTtn8B9Ga-Bw</recordid><startdate>20210301</startdate><enddate>20210301</enddate><creator>Stoop, Thomas F.</creator><creator>Ateeb, Zeeshan</creator><creator>Ghorbani, Poya</creator><creator>Scholten, Lianne</creator><creator>Arnelo, Urban</creator><creator>Besselink, Marc G.</creator><creator>Del Chiaro, Marco</creator><general>Springer International Publishing</general><general>Springer Nature B.V</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>3V.</scope><scope>7TO</scope><scope>7X7</scope><scope>7XB</scope><scope>88E</scope><scope>8AO</scope><scope>8FI</scope><scope>8FJ</scope><scope>8FK</scope><scope>ABUWG</scope><scope>AFKRA</scope><scope>BENPR</scope><scope>CCPQU</scope><scope>FYUFA</scope><scope>GHDGH</scope><scope>H94</scope><scope>K9.</scope><scope>M0S</scope><scope>M1P</scope><scope>PQEST</scope><scope>PQQKQ</scope><scope>PQUKI</scope><scope>7X8</scope><scope>ADTPV</scope><scope>AOWAS</scope><scope>D93</scope></search><sort><creationdate>20210301</creationdate><title>Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience</title><author>Stoop, Thomas F. ; Ateeb, Zeeshan ; Ghorbani, Poya ; Scholten, Lianne ; Arnelo, Urban ; Besselink, Marc G. ; Del Chiaro, Marco</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c501t-3979094f59d822777aa0fe58ded128c2502a043c65c74545a2e985c2afe404883</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2021</creationdate><topic>Adolescent</topic><topic>Adult</topic><topic>Elective Surgical Procedures</topic><topic>Hospital Mortality</topic><topic>Humans</topic><topic>Medicin och hälsovetenskap</topic><topic>Medicine</topic><topic>Medicine & Public Health</topic><topic>Morbidity</topic><topic>Mortality</topic><topic>Oncology</topic><topic>Pancreatectomy</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreatic Tumors</topic><topic>Retrospective Studies</topic><topic>Surgery</topic><topic>Surgical Oncology</topic><topic>Surgical outcomes</topic><topic>Treatment Outcome</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>Stoop, Thomas F.</creatorcontrib><creatorcontrib>Ateeb, Zeeshan</creatorcontrib><creatorcontrib>Ghorbani, Poya</creatorcontrib><creatorcontrib>Scholten, Lianne</creatorcontrib><creatorcontrib>Arnelo, Urban</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><creatorcontrib>Del Chiaro, Marco</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>ProQuest Central (Corporate)</collection><collection>Oncogenes and Growth Factors Abstracts</collection><collection>Health & Medical Collection</collection><collection>ProQuest Central (purchase pre-March 2016)</collection><collection>Medical Database (Alumni Edition)</collection><collection>ProQuest Pharma Collection</collection><collection>Hospital Premium Collection</collection><collection>Hospital Premium Collection (Alumni Edition)</collection><collection>ProQuest Central (Alumni) (purchase pre-March 2016)</collection><collection>ProQuest Central (Alumni Edition)</collection><collection>ProQuest Central UK/Ireland</collection><collection>ProQuest Central</collection><collection>ProQuest One Community College</collection><collection>Health Research Premium Collection</collection><collection>Health Research Premium Collection (Alumni)</collection><collection>AIDS and Cancer Research Abstracts</collection><collection>ProQuest Health & Medical Complete (Alumni)</collection><collection>Health & Medical Collection (Alumni Edition)</collection><collection>Medical Database</collection><collection>ProQuest One Academic Eastern Edition (DO NOT USE)</collection><collection>ProQuest One Academic</collection><collection>ProQuest One Academic UKI Edition</collection><collection>MEDLINE - Academic</collection><collection>SwePub</collection><collection>SwePub Articles</collection><collection>SWEPUB Umeå universitet</collection><jtitle>Annals of surgical oncology</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>Stoop, Thomas F.</au><au>Ateeb, Zeeshan</au><au>Ghorbani, Poya</au><au>Scholten, Lianne</au><au>Arnelo, Urban</au><au>Besselink, Marc G.</au><au>Del Chiaro, Marco</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience</atitle><jtitle>Annals of surgical oncology</jtitle><stitle>Ann Surg Oncol</stitle><addtitle>Ann Surg Oncol</addtitle><date>2021-03-01</date><risdate>2021</risdate><volume>28</volume><issue>3</issue><spage>1543</spage><epage>1551</epage><pages>1543-1551</pages><issn>1068-9265</issn><issn>1534-4681</issn><eissn>1534-4681</eissn><abstract>Background
The impact of high-volume care in total pancreatectomy (TP) is barely explored since annual numbers are mostly low. This study evaluated surgical outcomes after TP over time in a high-volume center.
Methods
All adult patients (age ≥ 18 years) who underwent an elective single-stage TP at Karolinska University Hospital were retrospectively analysed (2008–2017). High volume was defined as > 20 TPs/year.
Results
Overall, 145 patients after TP were included, including 86 (59.3%) extended resections. Major morbidity was 34.5% (50/145) and 90-day mortality 5.5% (8/145). The relative use of TP within all pancreatectomies increased from 5.4% (63/1175) in 2008–2015 to 17.3% (82/473) in 2016–2017 (
p
< 0.001). Over time, TP was more often performed to achieve radicality (
n
= 11, 17.5% to
n
= 31, 37.8%;
p
= 0.007). In multivariable logistic regression analysis, an annual TP-volume of > 20 was associated with reduced major morbidity (odds ratio [OR] = 0.225, 95% confidence interval [CI], 0.097–0.521;
p
< 0.001). In the high-volume years (2016–2017), major morbidity (
n
= 31, 49.2% to
n
= 19, 23.2%;
p
= 0.001) and relaparotomy rate (
n
= 13, 20.6% to
n
= 5, 6.1%;
p
= 0.009) improved. Improvements occurred mainly after extended TP, including lower major morbidity (
n
= 22, 57.9% to
n
= 12, 25.0%;
p
= 0.002) and in-hospital mortality (
n
= 3, 7.9% to
n
= 0, 0%;
p
= 0.082).
Conclusions
In a single, high-volume center study, an increase in surgical volume of TP was associated with improved perioperative outcomes, especially for extended resections.</abstract><cop>Cham</cop><pub>Springer International Publishing</pub><pmid>32761326</pmid><doi>10.1245/s10434-020-08957-x</doi><tpages>9</tpages></addata></record> |
| fulltext | fulltext |
| identifier | ISSN: 1068-9265 |
| ispartof | Annals of surgical oncology, 2021-03, Vol.28 (3), p.1543-1551 |
| issn | 1068-9265 1534-4681 1534-4681 |
| language | eng |
| recordid | cdi_swepub_primary_oai_swepub_ki_se_469146 |
| source | MEDLINE; SpringerLink Journals - AutoHoldings |
| subjects | Adolescent Adult Elective Surgical Procedures Hospital Mortality Humans Medicin och hälsovetenskap Medicine Medicine & Public Health Morbidity Mortality Oncology Pancreatectomy Pancreatic Neoplasms - surgery Pancreatic Tumors Retrospective Studies Surgery Surgical Oncology Surgical outcomes Treatment Outcome |
| title | Surgical Outcomes After Total Pancreatectomy: A High-Volume Center Experience |
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