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- Title
Quality Improvement for Surgical Resection of Pancreatic Head Adenocarcinoma : Hospital and Surgeon Predictors of Higher Than Expected R1 Resection Using the National Cancer Database.
- Authors
Nuckles, Brandon W.; Lam, Kenneth; Young, Katelyn A.; Dove, James T.; Shabahang, Mohsen M.; Blansfield, Joseph A.
- Abstract
<bold>Background: </bold>The mainstay of treatment for pancreatic cancer is surgical resection; however, positive surgical margins remain commonplace. We identified hospitals with higher than predicted rates of positive margins and isolated factors that caused this discordance.<bold>Methods: </bold>This is a retrospective review of patients with head of the pancreas adenocarcinoma in the National Cancer Database between 2004 and 2015. A nomogram was used to calculate the observed to expected positive margin rates (O/E) for facilities. If the O/E differed significantly (P < .05), it was considered an outlier.<bold>Results: </bold>Among a total of 19 968 patients, 24.3% had positive margins. Among hospitals with lower than expected positive margin rates, 73.6% were academic or research programs, 17% were comprehensive community cancer programs, and none were community cancer programs (P = .0002). Within the group with higher than expected positive margin rates, 47% were comprehensive community cancer programs and 38.6% were academic or research programs (P = .0002). The mean hospital volume was higher in the low positive margin group (110.4 vs 48.8, P < .0001).<bold>Conclusions: </bold>Facility type and hospital volume can predict improvement in the O/E ratio for margin positivity in pancreatic adenocarcinoma resection. Surgeons should consider referral to academic or research facilities with higher case volumes for improved surgical resection.
- Subjects
UNITED States; SURGICAL excision; SURGICAL margin; ADENOCARCINOMA; SURGEONS; ACADEMIC programs; PANCREATIC tumors; HOSPITALS; DATABASES; RETROSPECTIVE studies; QUALITY assurance; SURVIVAL analysis (Biometry); STATISTICAL models; PANCREATICODUODENECTOMY
- Publication
American Surgeon, 2021, Vol 87, Issue 3, p396
- ISSN
0003-1348
- Publication type
journal article
- DOI
10.1177/0003134820950281