Going the Extra Mile Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers
Going the Extra Mile Improved Survival for Pancreatic Cancer Patients Traveling to High-volume Centers
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DOI：
10.1097/sla.0000000000001924
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发表时间：
2017-08-01
影响因子：
9
通讯作者：
Blazer, Dan G., III
中科院分区：
文献类型：
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作者：
Lidsky, Michael E.;Sun, Zhifei;Blazer, Dan G., III
目的：本研究比较了在当地低容量中心治疗的患者和前往高容量中心治疗的患者进行胰十二指肠切除术（PD）后的结果。背景：尽管在高容量机构中PD的结果更好，但并非所有患者都住在主要医疗中心附近。上级。方法：在1998年至2012年国家癌症数据库中查询接受PD的T1- 3 N 0 - 1 M0胰腺癌患者。计算到治疗中心的旅行距离。将行程距离的上四分位数和下四分位数与机构容量重叠，建立了短行程/低容量（ST/LV）和长行程/高容量（LT/HV）队列。结果：7086例患者中，773例ST/LV患者每年旅行= 16 PD。LT/HV患者的疾病分期较高（P < 0.001），但切缘阳性率较低（20.5%vs25.9%，P = 0.01），淋巴结清扫率较高（16 vs 11个，P < 0.01）。此外，LT/HV患者的住院时间更短（9 vs 12天，P < 0.01），30天死亡率更低（2.0% vs 6.3%，P < 0.01），30天再入院率相似（10.1% vs 9.8%，P = 0.83）。尽管疾病更晚期，LT/HV患者的未校正生存期更优（20.3 vs 15.7个月）。调整后，前往高容量中心仍与长期死亡率降低相关（风险比0.75，P < 0.01）。结论：尽管增加了旅行负担，但在高容量中心治疗的患者改善了围手术期结局、短期死亡率和总生存率。这些数据支持正在进行的努力，集中照顾病人接受PD。
Objective: This study compares outcomes following pancreaticoduodenectomy (PD) for patients treated at local, low-volume centers and those traveling to high-volume centers.Background: Although outcomes for PD are superior at high-volume institutions, not all patients live in proximity to major medical centers. Theoretical advantages for undergoing surgery locally exist.Methods: The 1998 to 2012 National Cancer Data Base was queried for T1-3N0-1M0 pancreatic adenocarcinoma patients who underwent PD. Travel distances to treatment centers were calculated. Overlaying the upper and lower quartiles of travel distance with institutional volume established short travel/low-volume (ST/LV) and long travel/high-volume (LT/HV) cohorts. Overall survival was evaluated.Results: Of 7086 patients, 773 ST/LV patients traveled = 16 PDs yearly. LT/HV patients had higher stage disease (P < 0.001), but lower margin positivity (20.5% vs 25.9%, P = 0.01) and improved lymphadenectomy (16 vs 11 nodes, P < 0.01). Moreover, LT/HV patients had shorter hospitalizations (9 vs 12 days, P < 0.01) and lower 30-day mortality (2.0% vs 6.3%, P < 0.01) with similar 30-day readmission rates (10.1% vs 9.8%, P = 0.83). Despite more advanced disease, LT/HV patients had superior unadjusted survival (20.3 vs 15.7 months). After adjustment, travel to a high-volume center remained associated with reduced long-term mortality (hazard ratio 0.75, P < 0.01).Conclusions: Despite an increased travel burden, patients treated at highvolume centers had improved perioperative outcomes, short-term mortality, and overall survival. These data support ongoing efforts to centralize care for patients undergoing PD.