Study suggests surgery for pancreatic cancer should be more centralised

A new study has found that patients who receive surgery for pancreatic cancer have significantly better outcomes if they’re operated on by surgeons who perform the procedures multiple times per year.

Pancreatic cancer has the worst survival rate of any cancer. Surgery to remove the tumour is highly complex and carries significant risks of illness or death.

The study was led by the head of the Cancer Aetiology and Prevention Laboratory at QIMR Berghofer Medical Research Institute, Associate Professor Rachel Neale, and has been published in the Journal of Gastrointestinal Surgery.

Associate Professor Neale and her colleagues examined data from 270 patients in Queensland and New South Wales who received surgery for pancreatic cancer between July 2009 and June 2011.

The researchers compared the patient outcomes between those surgeons who performed the procedure four or more times per year (high-volume surgeons) and those who performed the operation fewer than four times per year (low-volume surgeons).

The researchers found that patients were far more likely to die from surgical complications if their operation was done by a low-volume surgeon. 5.6 per cent of patients with a low-volume surgeon died from surgical complications, compared to 0.7 per cent per cent of patients with a high-volume surgeon.

The study found that the patients of low-volume surgeons were about three times more likely to die within 90 days of the procedure than the patients of high-volume surgeons. 7 per cent of patients with a low-volume surgeon died within 90 days, compared to two per cent of patients with a high-volume surgeon.

The researchers also found that the patients of low-volume surgeons were twice as likely to die within 12 months of surgery as the patients of high-volume surgeons.

“It’s important to point out that these findings do not cast any aspersions on the competency of the surgeons who performed this procedure infrequently,” Associate Professor Neale said.

“Rather, this study shows that this highly complex and risky procedure is more likely to be successful if it’s done by a surgeon who performs it several times per year.

“The 270 operations we examined were performed by 79 surgeons. Our findings suggest that more patients would have better outcomes if this procedure was concentrated into the hands of a smaller number of surgeons.

“In other words, the evidence suggests that surgery for pancreatic cancer should be super-specialised.

“Some options to consider are whether guidelines should be implemented to ensure that suitably credentialed surgeons are completing an adequate number of these procedures per year, and, to facilitate this, whether this procedure should only be performed in certain hospitals, which would permit and aid this development of this super-specialisation.”

The study was funded by the National Health and Medical Research Council (NHMRC) and included collaborators from The University of Queensland; Cancer Council NSW; the Universities of Newcastle, Sydney, Western Sydney and NSW; The Queensland University of Technology; The Prince of Wales Hospital; and, the Royal Brisbane and Women’s Hospital.