Skip to main content

Advertisement

SpringerLink
Log in

Outcome Quality Standards in Pancreatic Oncologic Surgery

  • Gastrointestinal Oncology
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Purpose

To identify quality indicators and establish acceptable quality limits (AQLs) in pancreatic oncologic surgery using a formal statistical methodology.

Methods

Indicators have been identified through systematic literature reviews and guidelines for pancreatic surgery. AQLs were determined for each indicator with confidence intervals of 99.8 and 95 % above and below the weighted average by sample size from the different series examined.

Results

Several indicators have been identified with the following results as AQLs: resectability rate >59 %; morbidity, mortality, and pancreatic fistula rate in pancreaticoduodenectomy <55, <5, and <16 %, respectively; morbidity, mortality, and fistula rate in distal pancreatectomy <53, <4, and <31 %, respectively; number of lymph nodes retrieved >15; R1 resection <46 %; survival at 1, 3, and 5 years >54, >19, and >8 %, respectively.

Conclusions

A series of different indicators for quality surgical care outcome in pancreatic cancer, as well as their limits, have been determined according to a standard methodology.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Fig. 1
Fig. 2

Similar content being viewed by others

References

  1. Donabedian A. Evaluating the quality of medical care. Milbank Q. 2005;83:691–729.

    PubMed Central  PubMed  Google Scholar 

  2. Gouma DJ, van Geenen RC, van Gulik TM, de Haan RJ, de Wit LT, Busch OR, Obertop H. Rates of complications and death after pancreaticoduodenectomy: risk factors and the impact of hospital volume. Ann Surg. 2000;232:786–95.

    CAS  PubMed Central  PubMed  Google Scholar 

  3. Balzano G, Zerbi A, Capretti G, Rocchetti S, Capitanio V, Di Carlo V. Effect of hospital volume on outcome of pancreaticoduodenectomy in Italy. Br J Surg. 2008;95:357–62.

    CAS  PubMed  Google Scholar 

  4. Schmidt CM, Turrini O, Parikh P, et al. Effect of hospital volume, surgeon experience, and surgeon volume on patient outcomes after pancreaticoduodenectomy: a single-institution experience. Arch Surg. 2010;145:634–40.

    PubMed  Google Scholar 

  5. Brennan MF. Quality pancreatic cancer care: it’s still mostly about volume. J Natl Cancer Inst. 2009;101:837–8.

    PubMed  Google Scholar 

  6. Gooiker GA, van Gijn W, Wouters MW, Post PN, van de Velde CJ, Tollenaar RA; Signalling Committee Cancer of the Dutch Cancer Society. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg. 2011;98:485–94.

    CAS  PubMed  Google Scholar 

  7. Spiegelhalter DJ. Funnel plots for institutional comparison. Qual Saf Health Care. 2002;11:390–1.

    CAS  PubMed Central  PubMed  Google Scholar 

  8. Spiegelhalter DJ. Funnel plots for comparing institutional performance. Statist Med. 2005;24:1185–202.

    Google Scholar 

  9. Tempero MA, Behrman S, Ben-Josef E, et al.; National Comprehensive Cancer Network. Pancreatic adenocarcinoma: clinical practice guidelines in oncology. J Natl Compr Canc Netw. 2005;3:598–626.

    PubMed  Google Scholar 

  10. Tempero MA, Arnoletti JP, Behrman SW, et al.; National Comprehensive Cancer Networks. Pancreatic Adenocarcinoma, version 2.2012: featured updates to the NCCN Guidelines. J Natl Compr Canc Netw. 2012;10:703–13.

    CAS  PubMed Central  PubMed  Google Scholar 

  11. Van Laethem JL, Verslype C, Iovanna JL, et al. New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel. Ann Oncol. 2012;23:570–6.

    PubMed  Google Scholar 

  12. Yamaguchi K, Tanaka M, Committee for Revision of Clinical Guidelines for Pancreatic Cancer of Japan Pancreas Society. EBM-based Clinical Guidelines for Pancreatic Cancer 2009 from the Japan Pancreas Society: a synopsis. Jpn J Clin Oncol. 2011;41:836–40.

    PubMed  Google Scholar 

  13. Cascinu S, Falconi M, Valentini V, Jelic S; ESMO Guidelines Working Group. Pancreatic cancer: ESMO clinical practice guidelines for diagnosis, treatment and follow-up. Ann Oncol. 2010;21 Suppl 5:v55–8.

    PubMed  Google Scholar 

  14. Ujiki MB, Talamonti MS. Guidelines for the surgical management of pancreatic adenocarcinoma. Semin Oncol. 2007;34:311–20.

    PubMed  Google Scholar 

  15. Pancreatric Section, British Society of Gastroenterology; Pancreatic Society of Great Britain and Ireland; Association of Upper Gastrointestinal Surgeons of Great Britain and Ireland; Royal College of Pathologists; Special Interest Group for Gastro-Intestinal Radiology. Guidelines for the management of patients with pancreatic cancer periampullary and ampullary carcinomas. Gut. 2005; 54 Suppl 5:v1–16.

    Google Scholar 

  16. Evans DB, Jessup JM, Colacchio T. Pancreatic cancer surgical practice guidelines. Pancreatic Cancer Practice Guideline Committee. Oncology (Williston Park). 1997;11:1074–9.

    CAS  Google Scholar 

  17. Saldinger PF, Reilly M, Reynolds K, Raptopoulos V, Chuttani R, Steer ML, Matthews JB. Is CT angiography sufficient for prediction of resectability of periampullary neoplasms? J Gastrointest Surg. 2000;4:233–7.

    CAS  PubMed  Google Scholar 

  18. Valls C, Andía E, Sanchez A, et al. Dual-phase helical CT of pancreatic adenocarcinoma: assessment of resectability before surgery. AJR Am J Roentgenol. 2002;178:821–6.

    PubMed  Google Scholar 

  19. Minniti S, Bruno C, Biasiutti C, Tonel D, Falzone A, Falconi M, Procacci C. Sonography versus helical CT in identification and staging of pancreatic ductal adenocarcinoma. J Clin Ultrasound. 2003;31:175–82.

    PubMed  Google Scholar 

  20. Vargas R, Nino-Murcia M, Trueblood W, Jeffrey RB Jr. MDCT in Pancreatic adenocarcinoma: prediction of vascular invasion and resectability using a multiphasic technique with curved planar reformations. AJR Am J Roentgenol. 2004;182:419–25.

    PubMed  Google Scholar 

  21. Maire F, Sauvanet A, Trivin F, et al. Staging of pancreatic head adenocarcinoma with spiral CT and endoscopic ultrasonography: an indirect evaluation of the usefulness of laparoscopy. Pancreatology. 2004;4:436–40.

    PubMed  Google Scholar 

  22. Meszoely IM, Wang H, Hoffman JP. Preoperative chemoradiation therapy for adenocarcinoma of the pancreas: The Fox Chase Cancer Center experience, 1986–2003. Surg Oncol Clin N Am. 2004;13:685–96.

    PubMed  Google Scholar 

  23. House MG, Yeo CJ, Cameron JL, et al. Predicting resectability of periampullary cancer with three-dimensional computed tomography. J Gastrointest Surg. 2004;8:280–8.

    PubMed  Google Scholar 

  24. Soriano A, Castells A, Ayuso C, et al. Preoperative staging and tumor resectability assessment of pancreatic cancer: prospective study comparing endoscopic ultrasonography, helical computed tomography, magnetic resonance imaging, and angiography. Am J Gastroenterol. 2004;99:492–501.

    PubMed  Google Scholar 

  25. Borbath I, Van Beers BE, Lonneux M, Schoonbroodt D, Geubel A, Gigot JF, Deprez PH. Preoperative assessment of pancreatic tumors using magnetic resonance imaging, endoscopic ultrasonography, positron emission tomography and laparoscopy. Pancreatology 2005;5:553–61.

    PubMed  Google Scholar 

  26. Karmazanovsky G, Fedorov V, Kubyshkin V, Kotchatkov A. Pancreatic head cancer: accuracy of CT in determination of resectability. Abdom Imaging. 2005;30:488–500.

    CAS  PubMed  Google Scholar 

  27. Olivié D, Lepanto L, Billiard JS, Audet P, Lavallée JM. Predicting resectability of pancreatic head cancer with multi-detector CT. Surgical and pathologic correlation. JOP. 2007;8:753–8.

    PubMed  Google Scholar 

  28. Zamboni GA, Kruskal JB, Vollmer CM, Baptista J, Callery MP, Raptopoulos VD. Pancreatic adenocarcinoma: value of multidetector CT angiography in preoperative evaluation. Radiology. 2007;245:770–8.

    PubMed  Google Scholar 

  29. Yamada S, Takeda S, Fujii T, et al. Clinical implications of peritoneal cytology in potentially resectable pancreatic cancer: positive peritoneal cytology may not confer an adverse prognosis. Ann Surg. 2007;246:254–8.

    PubMed Central  PubMed  Google Scholar 

  30. Bao PQ, Johnson JC, Lindsey EH, et al. Endoscopic ultrasound and computed tomography predictors of pancreatic cancer resectability. J Gastrointest Surg. 2008;12:10–6.

    PubMed  Google Scholar 

  31. Ong SL, Garcea G, Thomasset SC, et al. Surrogate markers of resectability in patients undergoing exploration of potentially resectable pancreatic adenocarcinoma. J Gastrointest Surg. 2008;12:1068–73.

    CAS  PubMed  Google Scholar 

  32. Ho JM, Eysselein VE, Stabile BE. The value of endoscopic ultrasonography in predicting resectability and margins of resection for periampullary tumors. Am Surg. 2008;74:1026–9.

    PubMed  Google Scholar 

  33. Lee JK, Kim AY, Kim PN, Lee MG, Ha HK. Prediction of vascular involvement and resectability by multidetector-row CT versus MR imaging with MR angiography in patients who underwent surgery for resection of pancreatic ductal adenocarcinoma. Eur J Radiol. 2010;73:310–6.

    PubMed  Google Scholar 

  34. Maithel SK, Maloney S, Winston C, et al. Preoperative CA 19-9 and the yield of staging laparoscopy in patients with radiographically resectable pancreatic adenocarcinoma. Ann Surg Oncol. 2008;15:3512–20.

    PubMed  Google Scholar 

  35. Seicean A, Badea R, Mocan T, et al. Radial endoscopic ultrasonography in the preoperative staging of pancreatic cancer. J Gastrointestin Liver Dis. 2008;17:273–8.

    PubMed  Google Scholar 

  36. Strobel K, Heinrich S, Bhure U, et al. Contrast-enhanced 18F-FDG PET/CT: 1-stop-shop imaging for assessing the resectability of pancreatic cancer. J Nucl Med. 2008;49:1408–13.

    PubMed  Google Scholar 

  37. Shah D, Fisher WE, Hodges SE, Wu MF, Hilsenbeck SG, Charles Brunicardi F. Preoperative prediction of complete resection in pancreatic cancer. J Surg Res. 2008;147:216–20.

    PubMed  Google Scholar 

  38. Manak E, Merkel S, Klein P, Papadopoulos T, Bautz WA, Baum U. Resectability of pancreatic adenocarcinoma: assessment using multidetector-row computed tomography with multiplanar reformations. Abdom Imaging. 2009;34:75–80.

    PubMed  Google Scholar 

  39. Park HS, Lee JM, Choi HK, Hong SH, Han JK, Choi BI. Preoperative evaluation of pancreatic cancer: comparison of gadolinium-enhanced dynamic MRI with MR cholangiopancreatography versus MDCT. J Magn Reson Imaging. 2009;30:586–95.

    PubMed  Google Scholar 

  40. Croome KP, Jayaraman S, Schlachta CM. Preoperative staging of cancer of the pancreatic head: is there room for improvement? Can J Surg. 2010;53:171–4.

    PubMed Central  PubMed  Google Scholar 

  41. Kaneko OF, Lee DM, Wong J, Kadell BM, Reber HA, Lu DS, Raman SS. Performance of multidetector computed tomographic angiography in determining surgical resectability of pancreatic head adenocarcinoma. J Comput Assist Tomogr. 2010;34:732–8.

    PubMed  Google Scholar 

  42. Aziz AM, Said T, Poovathumkadavil A, Almulla A. Using multidetector CT in predicting resectability of pancreatic head tumors: surgical and pathologic correlation. J Egypt Natl Canc Inst. 2010;22:233–9.

    PubMed  Google Scholar 

  43. Kent TS, Raptopoulos V, Callery MP, Gautam S, Vollmer CM. Escalating computed tomography angiogram (CTA) grade predicts unresectability and margin status for pancreaticobiliary neoplasms. HPB (Oxford). 2010;12:115–22.

    PubMed Central  PubMed  Google Scholar 

  44. Büchler MW, Friess H, Wagner M, Kulli C, Wagener V, Z’Graggen K. Pancreatic fistula after pancreatic head resection. Br J Surg. 2000;87:883–9.

    PubMed  Google Scholar 

  45. Balcom JH 4th, Rattner DW, Warshaw AL, Chang Y, Fernandez-del Castillo C. Ten-year experience with 733 pancreatic resections: changing indications, older patients, and decreasing length of hospitalization. Arch Surg. 2001;136:391–8.

    PubMed  Google Scholar 

  46. Richter A, Niedergethmann M, Sturm JW, Lorenz D, Post S, Trede M. Long-term results of partial pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head: 25-year experience. World J Surg. 2003;27:324–9.

    PubMed  Google Scholar 

  47. Schmidt CM, Powell ES, Yiannoutsos CT, et al. Pancreaticoduodenectomy: a 20-year experience in 516 patients. Arch Surg. 2004;139:718–25.

    PubMed  Google Scholar 

  48. Munoz-Bongrand N, Sauvanet A, Denys A, Sibert A, Vilgrain V, Belghiti J. Conservative management of pancreatic fistula after pancreaticoduodenectomy with pancreaticogastrostomy. J Am Coll Surg. 2004;199:198–203.

    PubMed  Google Scholar 

  49. Farnell MB, Pearson RK, Sarr MG, et al. A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery. 2005;138:618–28.

    PubMed  Google Scholar 

  50. Bassi C, Falconi M, Molinari E, et al. Reconstruction by pancreaticojejunostomy versus pancreaticogastrostomy following pancreatectomy: results of a comparative study. Ann Surg. 2005;242:767–71.

    PubMed Central  PubMed  Google Scholar 

  51. Kazanjian KK, Hines OJ, Eibl G, Reber HA. Management of pancreatic fistulas after pancreaticoduodenectomy: results in 437 consecutive patients. Arch Surg. 2005;140:849–54.

    PubMed  Google Scholar 

  52. Winter JM, Cameron JL, Campbell KA, et al. 1423 pancreaticoduodenectomies for pancreatic cancer: A single-institution experience. J Gastrointest Surg. 2006;10:1199–210.

    PubMed  Google Scholar 

  53. DeOliveira ML, Winter JM, Schafer M, Cunningham SC, Cameron JL, Yeo CJ, Clavien PA. Assessment of complications after pancreatic surgery: a novel grading system applied to 633 patients undergoing pancreaticoduodenectomy. Ann Surg. 2006;244:931–7.

    PubMed Central  PubMed  Google Scholar 

  54. Aranha GV, Aaron JM, Shoup M, Pickleman J. Current management of pancreatic fistula after pancreaticoduodenectomy. Surgery. 2006;140:561–8.

    PubMed  Google Scholar 

  55. Carrère N, Sauvanet A, Goere D, et al. Pancreaticoduodenectomy with mesentericoportal vein resection for adenocarcinoma of the pancreatic head. World J Surg. 2006;30:1526–35.

    PubMed  Google Scholar 

  56. Grobmyer SR, Pieracci FM, Allen PJ, Brennan MF, Jaques DP. Defining morbidity after pancreaticoduodenectomy: use of a prospective complication grading system. J Am Coll Surg. 2007;204:356–64.

    PubMed  Google Scholar 

  57. Pratt WB, Maithel SK, Vanounou T, Huang ZS, Callery MP, Vollmer CM Jr. Clinical and economic validation of the International Study Group of Pancreatic Fistula (ISGPF) classification scheme. Ann Surg. 2007;245:443–51.

    PubMed Central  PubMed  Google Scholar 

  58. Schell MT, Barcia A, Spitzer AL, Harris HW. Pancreaticoduodenectomy: volume is not associated with outcome within an academic health care system. HPB Surg. 2008;2008:825940. doi:10.1155/2008/825940.59.

    PubMed Central  PubMed  Google Scholar 

  59. Schnelldorfer T, Ware AL, Sarr MG, et al. Long-term survival after pancreatoduodenectomy for pancreatic adenocarcinoma: is cure possible? Ann Surg. 2008;247:456–62.

    PubMed  Google Scholar 

  60. Veillette G, Dominguez I, Ferrone C, Thayer SP, McGrath D, Warshaw AL, Fernández-del Castillo C. Implications and management of pancreatic fistulas following pancreaticoduodenectomy: the Massachusetts General Hospital experience. Arch Surg. 2008;143:476–81.

    PubMed Central  PubMed  Google Scholar 

  61. Nikfarjam M, Sehmbey M, Kimchi ET, Gusani NJ, Shereef S, Avella DM, Staveley-O’Carroll KF. Additional organ resection combined with pancreaticoduodenectomy does not increase postoperative morbidity and mortality. J Gastrointest Surg. 2009;13:915–21.

    PubMed  Google Scholar 

  62. Haddad LB, Scatton O, Randone B, Andraus W, Massault PP, Dousset B, Soubrane O. Pancreatic fistula after pancreaticoduodenectomy: the conservative treatment of choice. HPB (Oxford). 2009;11:203–9.

    PubMed Central  PubMed  Google Scholar 

  63. Mukherjee S, Kocher HM, Hutchins RR, Bhattacharya S, Abraham AT. Impact of hospital volume on outcomes for pancreaticoduodenectomy: a single UK HPB centre experience. Eur J Surg Oncol. 2009;35:734–8.

    CAS  PubMed  Google Scholar 

  64. Busquets J, Fabregat J, Jorba R, et al. Surgical treatment of pancreatic adenocarcinoma by cephalic duodenopancreatectomy (part 1). Post-surgical complications in 204 cases in a reference hospital. Cir Esp. 2010;88:299–307.

    PubMed  Google Scholar 

  65. Bilimoria MM, Cormier JN, Mun Y, Lee JE, Evans DB, Pisters PW. Pancreatic leak after left pancreatectomy is reduced following main pancreatic duct ligation. Br J Surg. 2003;90:190–6.

    CAS  PubMed  Google Scholar 

  66. Balzano G, Zerbi A, Cristallo M, Di Carlo V. The unsolved problem of fistula after left pancreatectomy: the benefit of cautious drain management. J Gastrointest Surg. 2005;9:837–42.

    PubMed  Google Scholar 

  67. Pannegeon V, Pessaux P, Sauvanet A, Vullierme MP, Kianmanesh R, Belghiti J. Pancreatic fistula after distal pancreatectomy: predictive risk factors and value of conservative treatment. Arch Surg. 2006;141:1071–6.

    PubMed  Google Scholar 

  68. Sierzega M, Niekowal B, Kulig J, Popiela T. Nutritional status affects the rate of pancreatic fistula after distal pancreatectomy: a multivariate analysis of 132 patients. J Am Coll Surg. 2007;205:52–9.

    PubMed  Google Scholar 

  69. Kleeff J, Diener MK, Z’graggen K, et al. Distal pancreatectomy: risk factors for surgical failure in 302 consecutive cases. Ann Surg. 2007;245:573–82.

    PubMed Central  PubMed  Google Scholar 

  70. Ferrone CR, Warshaw AL, Rattner DW, et al. Pancreatic fistula rates after 462 distal pancreatectomies: staplers do not decrease fistula rates. J Gastrointest Surg. 2008;12:1691–7.

    PubMed Central  PubMed  Google Scholar 

  71. Goh BK, Tan YM, Chung YF, et al. Critical appraisal of 232 consecutive distal pancreatectomies with emphasis on risk factors, outcome, and management of the postoperative pancreatic fistula: a 21-year experience at a single institution. Arch Surg. 2008;143:956–65.

    PubMed  Google Scholar 

  72. Kooby DA, Gillespie T, Bentrem D, et al. Left-sided pancreatectomy: a multicenter comparison of laparoscopic and open approaches. Ann Surg. 2008;248:438–46.

    PubMed  Google Scholar 

  73. Vin Y, Sima CS, Getrajdman GI, Brown KT, Covey A, Brennan MF, Allen PJ. Management and outcomes of postpancreatectomy fistula, leak, and abscess: results of 908 patients resected at a single institution between 2000 and 2005. J Am Coll Surg. 2008;207:490–8.

    PubMed  Google Scholar 

  74. Nathan H, Cameron JL, Goodwin CR, et al. Risk factors for pancreatic leak after distal pancreatectomy. Ann Surg. 2009;250:277–81.

    PubMed  Google Scholar 

  75. Meyer W, Jurowich C, Reichel M, Steinhäuser B, Wünsch PH, Gebhardt C. Pathomorphological and histological prognostic factors in curatively resected ductal adenocarcinoma of the pancreas. Surg Today. 2000;30:582–7.

    CAS  PubMed  Google Scholar 

  76. Yeo CJ, Cameron JL, Lillemoe KD, et al. Pancreaticoduodenectomy with or without distal gastrectomy and extended retroperitoneal lymphadenectomy for periampullary adenocarcinoma, part 2: randomized controlled trial evaluating survival, morbidity, and mortality. Ann Surg. 2002;236:355–66.

    PubMed Central  PubMed  Google Scholar 

  77. Capussotti L, Massucco P, Ribero D, Viganò L, Muratore A, Calgaro M. Extended lymphadenectomy and vein resection for pancreatic head cancer: outcomes and implications for therapy. Arch Surg. 2003;138:1316–22.

    PubMed  Google Scholar 

  78. Berger AC, Watson JC, Ross EA, Hoffman JP. The metastatic/examined lymph node ratio is an important prognostic factor after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am Surg. 2004;70:235–40.

    PubMed  Google Scholar 

  79. Sierzega M, Popiela T, Kulig J, Nowak K. The ratio of metastatic/resected lymph nodes is an independent prognostic factor in patients with node-positive pancreatic head cancer. Pancreas. 2006;33:240–5.

    PubMed  Google Scholar 

  80. Pawlik TM, Gleisner AL, Cameron JL, et al. Prognostic relevance of lymph node ratio following pancreaticoduodenectomy for pancreatic cancer. Surgery. 2007;141:610–8.

    PubMed  Google Scholar 

  81. Zacharias T, Jaeck D, Oussoultzoglou E, Neuville A, Bachellier P. Impact of lymph node involvement on long-term survival after R0 pancreaticoduodenectomy for ductal adenocarcinoma of the pancreas. J Gastrointest Surg. 2007;11:350–6.

    PubMed  Google Scholar 

  82. House MG, Gönen M, Jarnagin WR, et al. Prognostic significance of pathologic nodal status in patients with resected pancreatic cancer. J Gastrointest Surg. 2007;11:1549–55.

    PubMed  Google Scholar 

  83. Smith RA, Bosonnet L, Ghaneh P, Raraty M, Sutton R, Campbell F, Neoptolemos JP. Preoperative CA19-9 levels and lymph node ratio are independent predictors of survival in patients with resected pancreatic ductal adenocarcinoma. Dig Surg. 2008;25:226–32.

    CAS  PubMed  Google Scholar 

  84. Riediger H, Keck T, Wellner U, zur Hausen A, Adam U, Hopt UT, Makowiec F. The lymph node ratio is the strongest prognostic factor after resection of pancreatic cancer. J Gastrointest Surg. 2009;13:1337–44.

    PubMed  Google Scholar 

  85. Hurtuk MG, Hughes C, Shoup M, Aranha GV. Does lymph node ratio impact survival in resected periampullary malignancies? Am J Surg. 2009;197:348–52.

    PubMed  Google Scholar 

  86. Murakami Y, Uemura K, Sudo T, et al. Number of metastatic lymph nodes, but not lymph node ratio, is an independent prognostic factor after resection of pancreatic carcinoma. J Am Coll Surg. 2010;211:196–204.

    PubMed  Google Scholar 

  87. Bhatti I, Peacock O, Awan AK, Semeraro D, Larvin M, Hall RI. Lymph node ratio versus number of affected lymph nodes as predictors of survival for resected pancreatic adenocarcinoma. World J Surg. 2010;34:768–75.

    PubMed  Google Scholar 

  88. Neoptolemos JP, Stocken DD, Dunn JA, et al. Influence of resection margins on survival for patients with pancreatic cancer treated by adjuvant chemoradiation and/or chemotherapy in the ESPAC-1 randomized controlled trial. Ann Surg. 2001;234:758–68.

    CAS  PubMed Central  PubMed  Google Scholar 

  89. Ahmad NA, Lewis JD, Ginsberg GG, et al. Long term survival after pancreatic resection for pancreatic adenocarcinoma. Am J Gastroenterol. 2001;96:2609–15.

    CAS  PubMed  Google Scholar 

  90. Kuhlmann KF, de Castro SM, Wesseling JG, et al. Surgical treatment of pancreatic adenocarcinoma; actual survival and prognostic factors in 343 patients. Eur J Cancer. 2004;40:549–58.

    CAS  PubMed  Google Scholar 

  91. Howard TJ, Krug JE, Yu J, et al. A margin-negative R0 resection accomplished with minimal postoperative complications is the surgeon’s contribution to long-term survival in pancreatic cancer. J Gastrointest Surg. 2006;10:1338–45.

    PubMed  Google Scholar 

  92. Raut CP, Tseng JF, Sun CC, et al. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007;246:52–60.

    PubMed Central  PubMed  Google Scholar 

  93. Kato K, Yamada S, Sugimoto H, et al. Prognostic factors for survival after extended pancreatectomy for pancreatic head cancer: influence of resection margin status on survival. Pancreas. 2009;38:605–12.

    PubMed  Google Scholar 

  94. Campbell F, Smith RA, Whelan P, Sutton R, Raraty M, Neoptolemos JP, Ghaneh P. Classification of R1 resections for pancreatic cancer: the prognostic relevance of tumour involvement within 1 mm of a resection margin. Histopathology. 2009;55:277–83.

    PubMed  Google Scholar 

  95. Lavu H, Mascaro AA, Grenda DR, et al. Margin positive pancreaticoduodenectomy is superior to palliative bypass in locally advanced pancreatic ductal adenocarcinoma. J Gastrointest Surg. 2009;13:1937–46.

    PubMed  Google Scholar 

  96. Hatzaras I, George N, Muscarella P, Melvin WS, Ellison EC, Bloomston M. Predictors of survival in periampullary cancers following pancreaticoduodenectomy. Ann Surg Oncol. 2010;17:991–7.

    PubMed Central  PubMed  Google Scholar 

  97. Fatima J, Schnelldorfer T, Barton J, et al. Pancreatoduodenectomy for ductal adenocarcinoma: implications of positive margin on survival. Arch Surg. 2010;145:167–72.

    PubMed  Google Scholar 

  98. Jamieson NB, Foulis AK, Oien KA, et al. Positive mobilization margins alone do not influence survival following pancreatico-duodenectomy for pancreatic ductal adenocarcinoma. Ann Surg. 2010;251:1003–10.

    PubMed  Google Scholar 

  99. Wenger FA, Peter F, Zieren J, Steiert A, Jacobi CA, Müller JM. Prognosis factors in carcinoma of the head of the pancreas. Dig Surg. 2000;17:29–35.

    CAS  PubMed  Google Scholar 

  100. Kedra B, Popiela T, Sierzega M, Precht A. Prognostic factors of long-term survival after resective procedures for pancreatic cancer. Hepatogastroenterology. 2001;48:1762–6.

    CAS  PubMed  Google Scholar 

  101. Cleary SP, Gryfe R, Guindi M, et al. Prognostic factors in resected pancreatic adenocarcinoma: analysis of actual 5-year survivors. J Am Coll Surg. 2004;198:722–31.

    PubMed  Google Scholar 

  102. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW. Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg. 2004;91:586–94.

    CAS  PubMed  Google Scholar 

  103. Kure S, Kaneko T, Takeda S, Inoue S, Nakao A. Analysis of long-term survivors after surgical resection for invasive pancreatic cancer. HPB (Oxford). 2005;7:129–34.

    PubMed Central  PubMed  Google Scholar 

  104. Han SS, Jang JY, Kim SW, Kim WH, Lee KU, Park YH. Analysis of long-term survivors after surgical resection for pancreatic cancer. Pancreas. 2006;32:271–5.

    PubMed  Google Scholar 

  105. Ferrone CR, Brennan MF, Gonen M, et al. Pancreatic adenocarcinoma: the actual 5-year survivors. J Gastrointest Surg. 2008;12:701–6.

    PubMed  Google Scholar 

  106. Katz MH, Wang H, Fleming JB, et al. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009;16:836–47.

    PubMed Central  PubMed  Google Scholar 

  107. Boggi U, Del Chiaro M, Croce C, et al. Prognostic implications of tumor invasion or adhesion to peripancreatic vessels in resected pancreatic cancer. Surgery. 2009;146:869–81.

    PubMed  Google Scholar 

  108. You DD, Lee HG, Heo JS, Choi SH, Choi DW. Prognostic factors and adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. J Gastrointest Surg. 2009;13:1699–706.

    PubMed  Google Scholar 

  109. Fabregat J, Busquets J, Peláez N, et al. Surgical treatment of pancreatic adenocarcinoma using cephalic duodenopancreatectomy (part 2). Long term follow up after 204 cases. Cir Esp. 2010;88:374–82.

    PubMed  Google Scholar 

  110. Vollmer ChM, Pratt W, Vanounou T, Maithel SK, Callery MP. Quality assessment in high-acuity surgery. Volume and mortality are not enough. Arch Surg. 2007;142:371–80.

    PubMed  Google Scholar 

  111. Riall TS, Nealon WH, Goodwin JS, Townsend CM, Freeman JL. Outcomes following pancreatic resection: variability among high-volume providers. Surgery. 2008;144:133–40.

    PubMed  Google Scholar 

  112. Dimick JB, Welch HG, Birkmeyer JD. Surgical mortality as an indicator of hospital quality. The problem with small sample size. JAMA 2004;292:847–51.

    CAS  PubMed  Google Scholar 

  113. Bilimoria KY, Bentrem DJ, Lillemoe KD, Talamonti MS, Ko CY. Assessment of pancreatic cancer care in the United States based on formally developed quality indicators. J Natl Cancer Inst. 2009;101:848–59.

    PubMed Central  PubMed  Google Scholar 

  114. Bassi C, Dervenis C, Butturini G, et al. Postoperative pancreatic fistula: an international study group (ISGPF) definition. Surgery. 2005;138:8–13.

    PubMed  Google Scholar 

  115. Dindo D, Demartines N, Clavien PA. Classification of surgical complications: a new proposal with evaluation in a cohort of 6336 patients and results of a survey. Ann Surg. 2004;240:205–13.

    PubMed Central  PubMed  Google Scholar 

  116. Esposito I, Kleeff J, Bergmann F, et al. Most pancreatic cancer resections are R1 resections. Ann Surg Oncol. 2008;15:1651–60.

    PubMed  Google Scholar 

  117. Gutierrez JC, Franceschi D, Koniaris LG. How many lymph nodes properly stage a periampullary malignancy? J Gastrointest Surg. 2008;12:77–85.

    PubMed  Google Scholar 

  118. Garcea G, Dennison AR, Pattenden CJ, Neal CP, Sutton CD, Berry DP. Survival following curative resection for pancreatic ductal adenocarcinoma. A systematic review of the literature. JOP. 2008;9:99–132.

    PubMed  Google Scholar 

Download references

Acknowledgment

The authors would like to thank Ms. Landy Menzies and Mr. Mervin Eyler for their language assistance in revising the English of this manuscript.

Disclosure

All the authors declare no commercial interest, no financial interest, and no material support related to this investigation.

Author information

Authors and Affiliations

  1. Department of Surgery, Hospital Clínico, University of Valencia, Valencia, Spain

    Luis Sabater PhD, Alvaro García-Granero MD & Joaquín Ortega PhD

  2. Department of Surgery, Hospital General Universitario de Castellón, Castellón, Spain

    Javier Escrig-Sos PhD

  3. Department of Pathology, Hospital Clínico University of Valencia, Valencia, Spain

    Maria del Carmen Gómez-Mateo MD & Antonio Ferrández PhD

  4. Department of Physiology, University of Valencia, Valencia, Spain

    Juan Sastre PhD

Authors
  1. Luis Sabater PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Alvaro García-Granero MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Javier Escrig-Sos PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Maria del Carmen Gómez-Mateo MD
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Juan Sastre PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Antonio Ferrández PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Joaquín Ortega PhD
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Luis Sabater PhD.

Electronic supplementary material

Below is the link to the electronic supplementary material.

Supplementary material 1 (DOC 1358 kb)

Rights and permissions

Reprints and permissions

About this article

Cite this article

Sabater, L., García-Granero, A., Escrig-Sos, J. et al. Outcome Quality Standards in Pancreatic Oncologic Surgery. Ann Surg Oncol 21, 1138–1146 (2014). https://doi.org/10.1245/s10434-013-3451-2

Download citation

  • Received:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1245/s10434-013-3451-2

Keywords

Search

Navigation