SAN FRANCISCO — Perioperative mortality associated with pancreatectomy in pancreatic cancer patients is improving, Dr. James T. McPhee reported at a symposium sponsored by the American Society of Clinical Oncology.
In 1998, 7.7% of patients died before leaving the hospital following pancreatectomy for neoplasm. That figure dropped to 4.4% by 2003, according to a retrospective analysis of 6,024 patients tracked through the National Inpatient Sample, a representative database of 994 hospitals in 37 states.
“Pancreatic resection remains the only curative intervention for pancreatic cancer,” noted Dr. McPhee, a surgeon at the University of Massachusetts Memorial Medical Center in Worcester. Mortality was considerably lower in hospitals with a high volume of the difficult surgeries, Dr. McPhee said at the symposium.
By 2003, the in-hospital mortality rate at hospitals performing more than 13 pancreatectomies per year was 2%, down from 2.8% in 1998. That compared with 8.3% in 2003 and 14% in 1998 at low-volume hospitals, defined as those performing fewer than four of the procedures a year.
Perioperative mortality at centers that did 4–13 cases per year fell into the midrange between the high- and low-volume hospitals. The overall in-hospital mortality rate for all hospitals over the 6-year period was 5.8%.
A multivariate regression analysis determined that surgical volume was the most powerful independent variable linked to mortality. Other negative predictors included advanced age, male gender, and, to a lesser degree, the year of the surgery.
“Could the decrease in mortality over time reflect a paradigm shift whereby a higher percentage of pancreatic resections are being performed at high-volume surgical centers?” Dr. McPhee asked.
A look at total cases and potential confounders “lends some credence,” to that theory, he said. Certainly, more cancer patients are undergoing pancreatectomy at high-volume centers: 40% in 2003, compared with 32% in 1998.
Furthermore, high-volume centers do not appear to be doing less complex cases, which could serve as a possible explanation for the mortality disparity, he said.
Although data were not available on every patient's race or socioeconomic status, two important potential confounders—age and gender—appeared well balanced between high- and low-volume centers, Dr. McPhee and his associates found.
The gastrointestinal cancer symposium was also sponsored by the American Gastroenterological Association, the American Society for Therapeutic Radiation and Oncology, and the Society of Surgical Oncology.
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