caa a22 4500 445334193 CHVBK 20180317142748.0 cr unu---uuuuu 170323e20110701xx s 000 0 eng 10.1245/s10434-010-1511-4 doi (NATIONALLICENCE)springer-10.1245/s10434-010-1511-4 Quality Improvement of Pancreatic Surgery by Centralization in the Western Part of the Netherlands [Elektronische Daten] [Gea Gooiker, Lydia van der Geest, Michel Wouters, Marieke Vonk, Tom Karsten, Rob Tollenaar, Bert Bonsing] Background: Centralization of pancreatic surgery in high-volume hospitals is under debate in many countries. In the western part of the Netherlands, the professional network of surgical oncologists agreed to centralize all pancreatic surgery from 2006 in two high-volume hospitals. Our aim is to evaluate whether centralization of pancreatic surgery has improved clinical outcomes and has changed referral patterns. Materials and Methods: Data of the Comprehensive Cancer Centre West (CCCW) of all 249 patients who had a resection for suspected pancreatic cancer between 1996 and 2008 in the western part of the Netherlands were analyzed. Multivariable modeling was used to evaluate survival for 3 time periods; 1996-2000, 2001-2005 (introduction of quality standards), and 2006-2008 (after centralization). In addition, the differences in referral pattern were analyzed. Results: From 2006, all pancreatic surgery was centralized in 2 hospitals. The 2-year survival rate increased after centralization from 39% to 55% (P=.09) for all patients who had a pancreatic resection for pancreatic cancer. After adjustment for age, tumor location, stage, histology, and adjuvant treatment, the latter period was significantly associated with improved survival (hazard ratio [HR] 0.50; 95% confidence interval [95% CI] 0.34-0.73). Conclusions: Centralization of pancreatic surgery was successful and has resulted in improved clinical outcomes in the western part of the Netherlands, demonstrating the effectiveness of centralization. The Author(s), 2011 Gooiker Gea Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut van der Geest Lydia Comprehensive Cancer Centre West, Leiden, The Netherlands aut Wouters Michel Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut Vonk Marieke Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut Karsten Tom Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands aut Tollenaar Rob Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut Bonsing Bert Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1821-1829 1068-9265 18:7<1821 2011 18 10434 https://doi.org/10.1245/s10434-010-1511-4 text/html Onlinezugriff via DOI 1 research-article jats NATIONALLICENCE 856 40 https://doi.org/10.1245/s10434-010-1511-4 text/html Onlinezugriff via DOI NATIONALLICENCE 700 1- Gooiker Gea Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut NATIONALLICENCE 700 1- van der Geest Lydia Comprehensive Cancer Centre West, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Wouters Michel Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Vonk Marieke Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Karsten Tom Department of Surgery, Reinier de Graaf Hospital, Delft, The Netherlands aut NATIONALLICENCE 700 1- Tollenaar Rob Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut NATIONALLICENCE 700 1- Bonsing Bert Department of Surgery, Leiden University Medical Centre, Leiden, The Netherlands aut NATIONALLICENCE 773 0- Annals of Surgical Oncology Springer-Verlag 18/7(2011-07-01), 1821-1829 1068-9265 18:7<1821 2011 18 10434 Metadata rights reserved Springer special CC-BY-NC licence nationallicence BK010053 XK010053 XK010000 NATIONALLICENCE NATIONALLICENCE NL-springer