Aparicio-López Daniel, Ramia José M, Villodre Celia, Rubio-García Juan J, Hernández Belén, Busquets Juli, Secanella Luis, Peláez Nuria, Alkorta Maialen, de-Ariño-Hervás Itziar, Achalandabaso Mar, Toledo-Martínez Enrique, Rotellar Fernando, Martí-Cruchaga Pablo, Gómez-Bravo Miguel A, Suárez-Artacho Gonzalo, Garcés-Albir Marina, Sabater Luis, García-Plaza Gabriel, Alcalá Francisco J, Asensio Enrique, Pacheco David, Cugat Esteban, Espín Francisco, Galófre-Recasens María, Sánchez-Pérez Belinda, Santoyo-Santoyo Julio, Calvo Jorge, Loinaz Carmelo, García-Domingo María I, Sánchez-Cabús Santiago, Martín-Arnau Belén, Blanco-Fernández Gerardo, Jaén-Torrejimeno Isabel, Domingo-Del-Pozo Carlos, Payá Carmen, González Carmen, Etxebarría Eider, López-Andújar Rafael, Ballester Cristina, Vico-Arias Ana B, Zambudio-Carroll Natalia, Estévez Sergio, Nogueira-Sixto Manuel, Miota José I, Conde Belén, Suárez-Muñoz Miguel A, Roldán-de-la-Rua Jorge, Blanco-Rodríguez Angélica, González Manuel, González-de-Chaves-Rodríguez Pilar E, Reyes-Correa Betsabé, López-Ben Santiago, Tió Berta, Mínguez Javier, Lasa-Unzué Inmaculada, Miyar Alberto, Solar Lorena, Burdío Fernando, Ielpo Benedetto, Carabias Alberto, Sanz-Muñoz María P, Escartín Alfredo, Vela Fulthon, Marqués Elia, Pérez Adelino, Palomares Gloria, Calvo-Córdoba Antonio, Castell José T, Castro María J, Manzanares María C, Artigues Enrique, Blas Juan L, Díez Luis, Calero Alicia, Quiñones José, Rodríguez Mario, Alcázar-López Cándido F, Serradilla-Martín Mario
Department of Surgery, Hospital Universitario San Jorge, 22004 Huesca, Spain.
Department of Surgery, Hospital General Universitario Dr. Balmis, 03010 Alicante, Spain.
J Clin Med. 2025 Aug 25;14(17):6013. doi: 10.3390/jcm14176013.
Like many other countries, the management of pancreatic cancer in Spain has developed in a fragmented manner. This study analyzes clinical outcomes related to patient volume at different centers after left pancreatectomy (LP). Our goal is to determine whether our practices align with the standards established in the literature and assess whether centralization's advantages significantly outweigh its disadvantages. The SPANDISPAN Project (SPANish DIStal PANcreatectomy) is an observational, prospective, multicenter study focused on LP conducted in Spanish Hepato-Pancreato-Biliary (HPB) Surgery Units from 1 February 2022 to 31 January 2023. HPB units were defined as high volume if they performed more than 10 LPs annually. This study included 313 patients who underwent LP at 42 centers across Spain over the course of a year. A total of 40.3% of the procedures were performed in high-volume centers. Significant differences in preoperative variables were only observed in ASA scores, which were higher in the high-volume group. Intraoperatively, minimally invasive surgical techniques were performed more frequently in high-volume centers. Postoperatively, the administration of somatostatin, major complications, and B and C postoperative pancreatic fistula (POPF) were more frequent in low-volume hospitals. The findings revealed that high-volume centers had a higher rate of minimally invasive surgery, lower intraoperative bleeding, fewer complications, and reduced POPFs compared to low-volume centers. However, it is important to note that low-volume centers still demonstrated acceptable outcomes. Thus, the selective referral of more complex laparoscopic procedures could initiate a gradual centralization of surgical practices.
与许多其他国家一样，西班牙胰腺癌的管理发展方式较为零散。本研究分析了左半胰切除术（LP）后不同中心患者数量与临床结局的关系。我们的目标是确定我们的做法是否符合文献中确立的标准，并评估集中化的优势是否明显大于其劣势。SPANDISPAN项目（西班牙远端胰腺切除术）是一项观察性、前瞻性、多中心研究，于2022年2月1日至2023年1月31日在西班牙肝胰胆（HPB）外科单位进行，重点关注LP。如果HPB单位每年进行超过10例LP，则被定义为高容量单位。本研究纳入了在西班牙42个中心接受LP手术的313例患者，为期一年。总共40.3%的手术在高容量中心进行。术前变量仅在ASA评分上存在显著差异，高容量组的评分更高。术中，高容量中心更频繁地采用微创外科技术。术后，低容量医院更频繁地使用生长抑素、发生重大并发症以及出现B级和C级术后胰瘘（POPF）。研究结果显示，与低容量中心相比，高容量中心的微创手术率更高、术中出血更少、并发症更少且POPF发生率更低。然而，需要注意的是，低容量中心的结局仍可接受。因此，选择性转诊更复杂的腹腔镜手术可以启动手术实践的逐步集中化。
