Stefano Crippa, Giulio Belfiori, Federico De Stefano, Gianpaolo Balzano, Francesco Ardito, Andrea Barberis, Ugo Boggi, Fulvio Calise, Silvia Caregari, Fabio Casciani, Marco Angelo Cereda, Leonardo Centonze, Nicola Cillara, Umberto Cillo, Eugenio Cocozza, Annalisa Comandatore, Antonello Deserra, Giulia Deiana, Gregorio Di Franco, Fabio Francesco Di Mola, Francesca Di Salvo, Pierluigi Di Sebastiano, Stefano D'Ugo, Giorgio Ercolani, Giuseppe Maria Ettorre, Giovanni Carlo Ferrari, Alessandro Ferrero, Gianluca Garulli, Alessandro Giani, Luca Vittorio Gianotti, Tommaso Giuliani, Felice Giuliante, Alfredo Guglielmi, Emanuele Kauffmann, Serena Langella, Andrea Lauterio, Gabriella Lionetto, Lorenzo Livraghi, Giuseppe Malleo, Giovanni Marchegiani, Marco Massani, Michele Mazzola, Riccardo Memeo, Roberto Luca Meniconi, Luca Morelli, Gennaro Nappo, Niccolo' Napoli, Cristina Nistri, Michele Pagnanelli, Alberto Patriti, Filippo Petrelli, Edoardo Poletto, Alberto Porcu, Alessandro Puzziello, Claudio Ricci, Allegra Ripolli, Roberta Rossi, Andrea Ruzzenente, Giulia Sandroni, Giuseppe Sena, Marcello Spampinato, Cosimo Sperti, Michele Tedeschi, Luigi Veneroni, Marco Vivarelli, Alessandro Zerbi, Roberto Salvia, Riccardo Casadei, Massimo Falconi
Considerable heterogeneity persists in PDAC management across Italy. According to the national criteria for the accreditation of Pancreas Units, 21.5% of patients could be treated in centers that fail to meet minimum standards, while an additional 5.9% receive care in high-volume centers where the 90-day mortality still exceeds 5%.
INTRODUCTION: Although surgical volume has a well-known association with outcomes in pancreatic surgery, volume alone does not necessarily guarantee quality for pancreatic ductal adenocarcinoma (PDAC). The study aimed to provide an overview of current surgical practices and short-term outcomes for PDAC in Italy.
METHODS: A retrospective multicentre study was conducted including all patients who underwent surgery for PDAC at 29 centers between 2018 and 2021. Centers were categorized by annual pancreatic surgical volume as low (1-10), medium (11-50), high (51-100), and very-high (> 100). The primary outcome was 90-day postoperative mortality.
RESULTS: A total of 3455 patients were included, treated in low- (n = 26), medium- (n = 1103), high- (n = 322), and very-high-volume (n = 2004) centers. The median PDAC-surgeries per year was 27 (IQR 23-28) in high- and 107 (IQR 64-204) in very-high-volume centers. Preoperative histological diagnosis was obtained in 66.6% of cases (n = 1335/2004) in very-high, 45.7% (n = 504/1103) in medium-, and 23.3% (n = 75/322) in high-volume centers. The overall resection rate was 90.7% (n = 3134/3455), while the remainder underwent exploration or palliative surgery. Ninety-day mortality among resected cases was 10% (n = 2/20), 5.3% (n = 51/961), 5.1% (n = 15/294), and 3.4% (n = 63/1859) in low-, medium-, high-, and very-high-volume centers, respectively.
CONCLUSION: Considerable heterogeneity persists in PDAC management across Italy. According to the national criteria for the accreditation of Pancreas Units, 21.5% of patients could be treated in centers that fail to meet minimum standards, while an additional 5.9% receive care in high-volume centers where the 90-day mortality still exceeds 5%.