Abstract：
Pancreatic cancer remains a highly fatal disease with a 5-year overall survival of less than 10%. In seeking to improve clinical outcomes, there is ongoing debate about the weight that should be given to patient volume in centralization models. The aim of this systematic review is to examine the relationship between patient volume and clinical outcome after pancreatic resection for cancer in the contemporary literature.
The Google Scholar, PubMed, and Cochrane Library databases were systematically searched from February 2015 until June 2021 for articles reporting patient volume and outcomes after pancreatic cancer resection.
There were 46 eligible studies over a 6-year period comprising 526,344 patients. The median defined annual patient volume thresholds varied: low-volume 0 (range 0-9), medium-volume 9 (range 3-29), high-volume 19 (range 9-97), and very-high-volume 28 (range 17-60) patients. The latter 2 were associated with a significantly lower 30-day mortality (P < .001), 90-day mortality (P < .001), overall postoperative morbidity (P = .005), failure to rescue rate (P = .006), and R0 resection rate (P = .008) compared with very-low/low-volume hospitals. Centralization was associated with lower 30-day mortality in 3 out of 5 studies, while postoperative morbidity was similar in 4 out of 4 studies. Median survival was longer in patients traveling greater distance for pancreatic resection in 2 out of 3 studies. Median and 5-year survival did not differ between urban and rural settings.
The contemporary literature confirms a strong relationship between patient volume and clinical outcome for pancreatic cancer resection despite expected bias toward more complex surgery in high-volume centers. These outcomes include lower mortality, morbidity, failure-to-rescue, and positive resection margin rates.
The Google Scholar, PubMed, and Cochrane Library databases were systematically searched from February 2015 until June 2021 for articles reporting patient volume and outcomes after pancreatic cancer resection.
There were 46 eligible studies over a 6-year period comprising 526,344 patients. The median defined annual patient volume thresholds varied: low-volume 0 (range 0-9), medium-volume 9 (range 3-29), high-volume 19 (range 9-97), and very-high-volume 28 (range 17-60) patients. The latter 2 were associated with a significantly lower 30-day mortality (P < .001), 90-day mortality (P < .001), overall postoperative morbidity (P = .005), failure to rescue rate (P = .006), and R0 resection rate (P = .008) compared with very-low/low-volume hospitals. Centralization was associated with lower 30-day mortality in 3 out of 5 studies, while postoperative morbidity was similar in 4 out of 4 studies. Median survival was longer in patients traveling greater distance for pancreatic resection in 2 out of 3 studies. Median and 5-year survival did not differ between urban and rural settings.
The contemporary literature confirms a strong relationship between patient volume and clinical outcome for pancreatic cancer resection despite expected bias toward more complex surgery in high-volume centers. These outcomes include lower mortality, morbidity, failure-to-rescue, and positive resection margin rates.
摘要：
胰腺癌仍然是一种高度致命的疾病，5年总生存率不到10%。在寻求改善临床结果时，关于在集中式模型中应该给予患者体积权重的争论仍在进行。本系统综述的目的是研究当代文献中胰腺癌切除术后患者体积与临床结局之间的关系。
谷歌学者,PubMed,从2015年2月至2021年6月,系统检索了CochraneLibrary数据库中报告胰腺癌切除术后患者体积和结局的文章.
在6年的时间里，共有46项符合条件的研究，包括526,344名患者。定义的年患者容量阈值的中位数各不相同：低容量0（范围0-9），中等体积9（范围3-29），高容量19（范围9-97），和非常高容量的28（范围17-60）患者。后2与显著降低30天死亡率相关(P<.001),90天死亡率（P<.001），术后总发病率（P=0.005），抢救失败率（P=.006），与非常低/低容量医院相比，R0切除率（P=.008）。在5项研究中，有3项研究中，集中化与30天死亡率较低相关。而4项研究中有4项的术后发病率相似。在3项研究中，有2项进行胰腺切除术的患者的中位生存期更长。城市和农村地区的中位和5年生存率没有差异。
当代文献证实了胰腺癌切除的患者体积和临床结果之间的密切关系，尽管预期在高容量中心会倾向于更复杂的手术。这些结果包括较低的死亡率，发病率，救援失败，和阳性切缘率。
谷歌学者,PubMed,从2015年2月至2021年6月,系统检索了CochraneLibrary数据库中报告胰腺癌切除术后患者体积和结局的文章.
在6年的时间里，共有46项符合条件的研究，包括526,344名患者。定义的年患者容量阈值的中位数各不相同：低容量0（范围0-9），中等体积9（范围3-29），高容量19（范围9-97），和非常高容量的28（范围17-60）患者。后2与显著降低30天死亡率相关(P<.001),90天死亡率（P<.001），术后总发病率（P=0.005），抢救失败率（P=.006），与非常低/低容量医院相比，R0切除率（P=.008）。在5项研究中，有3项研究中，集中化与30天死亡率较低相关。而4项研究中有4项的术后发病率相似。在3项研究中，有2项进行胰腺切除术的患者的中位生存期更长。城市和农村地区的中位和5年生存率没有差异。
当代文献证实了胰腺癌切除的患者体积和临床结果之间的密切关系，尽管预期在高容量中心会倾向于更复杂的手术。这些结果包括较低的死亡率，发病率，救援失败，和阳性切缘率。
