Department of General, Visceral and Thoracic Surgery, University Medical Centre, Hamburg-Eppendorf, Hamburg, Germany.
Department of General Visceral and Thoracic Surgery, University of Hamburg Medical Institutions, Martinistr 52, 20252, Hamburg, Germany.
J Gastrointest Surg. 2019 Oct;23(10):2081-2092. doi: 10.1007/s11605-019-04215-y. Epub 2019 Apr 29.
The objective of this article is a review and an analysis of the current state of centralization of pancreatic surgery in Europe. Numerous recent publications demonstrate higher postoperative in-hospital mortality rates in low-volume clinics after pancreatic resection than previously assumed due to their not publishing significantly worse outcomes when compared to high-volume centres. Although the benefits of centralization of pancreatic surgery in high-volume centres have been demonstrated in many studies, numerous countries have so far failed to establish centralization in their respective health care systems.
A systematic literature search of the Medline database for studies concerning centralization of pancreatic surgery in Europe was conducted. The studies were reviewed independently for previously defined inclusion and exclusion criteria. We included 14 studies with a total of 117,634 patients. All data were extracted from or provided by health insurance company or governmental registry databases.
Thirteen out of the 14 studies demonstrate an improvement in their respective outcome related to volume. Twelve studies showed a significantly lower postoperative mortality rate in the highest annual volume group in comparison to overall postoperative mortality rate in the whole patient cohort.
As the available data indicate, most European countries have so far failed to establish centralization of pancreatic surgery to high-volume centres due to numerous reasons. Considering a plateau in survival rates of patients undergoing treatment for pancreatic cancer in Europe during the last 15 years, this review enforces the worldwide plea for centralization to lower post-operative mortality after pancreatic surgery.
本文旨在回顾和分析欧洲胰腺外科中心化的现状。由于低容量诊所未公布明显较差的结果，最近许多出版物表明，与高容量中心相比，胰腺切除术后其术后住院死亡率更高，这与之前的假设不同。尽管高容量中心胰腺外科中心化的益处已在许多研究中得到证实，但迄今为止，许多国家尚未在各自的医疗保健系统中建立中心化。
对 Medline 数据库中有关欧洲胰腺外科中心化的研究进行了系统文献检索。根据之前定义的纳入和排除标准，对这些研究进行了独立审查。我们纳入了 14 项研究，共涉及 117634 名患者。所有数据均来自或由健康保险公司或政府登记处数据库提供。
14 项研究中有 13 项表明其相关结果与容量有关。12 项研究显示，与整个患者队列的术后总死亡率相比，最高年容量组的术后死亡率显著降低。
由于种种原因，大多数欧洲国家迄今尚未将胰腺外科中心化到高容量中心。考虑到欧洲在过去 15 年中接受胰腺癌治疗的患者生存率已达到稳定水平，因此，该综述强调了在全球范围内倡导将胰腺外科中心化以降低术后死亡率的必要性。
