Shinde Rajesh S, Pandrowala Saneya, Navalgund Sunil, Pai Esha, Bhandare Manish S, Chaudhari Vikram A, Sullivan Richard, Shrikhande Shailesh V
Gastrointestinal and Hepato-Pancreato-Biliary Service, Division of Cancer Surgery, Department of Surgical Oncology, Tata Memorial Hospital, Homi Bhabha National Institute, Mumbai, Maharashtra, 400012, India.
Institute of Cancer Policy, King's College London, Guys and St Thomas' NHS Foundation Trust, London, UK.
World J Surg. 2020 Jul;44(7):2367-2376. doi: 10.1007/s00268-020-05466-6.
The volume-outcome relationship dictates that high-volume centres lead to improved patient outcomes after pancreatoduodenectomy (PD). We conducted a retrospective review to fathom the situation in India for PD and whether referral to high-volume centres would make a positive impact.
A systematic literature search in MEDLINE was performed, and all articles published from Indian centres from 01.03.2008 to 30.11.2019 were scrutinised. Any series with less than 20 patients, case reports, abstracts, unpublished data and personal communications were excluded.
A total of 36 unique series including 6226 patients from 24 institutes across India were identified. Amongst the 24 institutes, 2 institutes reported less than 10 cases/year, 11 reported 10-25 cases/year and 11 reported ≥26 cases/year. Overall perioperative morbidity was 42.4%, 43.4% and 41% for centres doing <10, 10-25 and ≥26 cases/year, respectively. Operative mortality also improved with increasing number of cases/year (5.1% vs. 6.6% vs. 3.2%, respectively).
With increasing volume of cases per year, trend towards improved PD outcomes is observed. To optimise the use of healthcare facilities, it would be pragmatic to consider building an organised referral system for complex surgeries to deliver unsurpassed patient care with maximum utilisation of the available healthcare infrastructure.
手术量-预后关系表明，高手术量中心可改善胰十二指肠切除术（PD）后的患者预后。我们进行了一项回顾性研究，以了解印度PD的情况，以及转诊至高手术量中心是否会产生积极影响。
在MEDLINE中进行了系统的文献检索，并仔细审查了2008年3月1日至2019年11月30日期间印度各中心发表的所有文章。排除患者少于20例的任何系列研究、病例报告、摘要、未发表的数据和个人交流。
共确定了36个独立系列研究，包括来自印度24家机构的6226例患者。在这24家机构中，2家机构报告每年病例数少于10例，11家报告每年10 - 25例，11家报告每年≥26例。每年进行<10例、10 - 25例和≥26例手术的中心，总体围手术期发病率分别为42.4%、43.4%和41%。手术死亡率也随着每年病例数的增加而改善（分别为5.1%、6.6%和3.2%）。
随着每年病例数的增加，观察到PD预后有改善趋势。为优化医疗设施的使用，考虑建立一个针对复杂手术的有组织的转诊系统，以在最大程度利用现有医疗基础设施的情况下提供卓越的患者护理，这将是务实的做法。
