18. Long-Term Survival Is Superior After Pancreatic Or Hepatic Resections For Cancer In High Volume Centers
Yuman Fong, MD, Mithat Gonen, PhD.*, David Rubin, BS*, Mark Radzner, BS*, Murray F. Brennan, MD
Memorial Sloan-Kettering Cancer Center, New York, NY
BACKGROUND: A number of studies have demonstrated that surgical resection at high volume centers is associated with improved short-term peri-operative outcome. Whether long-term results after resection of visceral malignancies are superior at high volume centers is unknown.
METHODS: All patients who were subjected to pancreatectomy or hepatectomy for cancer in the years 1995 and 1996 were identified in the National Medicare database. Data extracted and examined include demographics, comorbidities, and long-term survival. All survival was confirmed through 2001, providing actual five-year survival. Long-term survival was examined as related to hospital volume.
RESULTS: In the study period, there were 2592 pancreatectomies and 3734 hepatectomies performed at 1523 and 1465 institutions respectively. High volume center was defined as >25 cases/year. By this definition, there were 10 high volume centers for pancreatectomy, and 12 centers for hepatectomy; performing 11% (n=291) of the pancreatectomies, and 12% (n=474) of the hepatectomies in this study period. The long term survivals are shown. Comparison by Log-rank demonstrated superior survival for patients resected at high volume centers (pancreatectomy: p= 0.001; hepatectomy: p=0.02).
CONCLUSION: Superior long term survival is associated with complex visceral resections for cancer at high volume centers.