Het volume van chirurgische ingrepen en de impact ervan op ... - KCE

80 Volume Outcome KCE reports 113
5.3.7.2 Summarized results of literature review
The systematic literature search identified 9 systematic reviews in which the volume
1, 5, 59, 60, 62, 64, 69, 71,
outcome association (VOA) for pancreatic cancer surgery was studied.
72 115-117, 129, 131, 133, 135, 141, 142,
These systematic reviews were based on 25 primary studies.
155, 157-171
An additional search for more recent studies which were published in the
period 2004-2009 resulted in 8 additional primary studies. 50, 153, 156, 172-176 This brings us to
a total of 33 primary studies that analyzed the volume outcome association for
pancreatic cancer surgery. For more insight in how these studies were retrieved see the
Supplement.
On the basis of the systematic reviews it was concluded in Chapter 2 (see Table 2.2 on
page 19) that there is evidence for an inverse relation between hospital volume and
mortality for pancreatic cancer surgery. This means that mortality decreases when the
number of procedures performed by a hospital increases. A similar relationship was
found between surgeon volume and mortality.
With respect to pancreatic resection for malignant disease, Killeen et al. found that the
number needed to treat for a high-volume provider to prevent one death is 10 to 15
patients. 69
One minimal hospital volume threshold was retained from the literature search i.e. 11
pancreatic resections per annum. This thresholds correspond more or less with the
thresholds in the systematic reviews, but, more importantly, it corresponds with the
threshold issued by the US Agency for Healthcare Research and Quality (AHRQ) and
29, 126
the US Leapfrog Group.
Detailed results of the literature review are described in the evidence tables in
Appendix 8.
5.3.7.3 Comparative analysis of literature and Belgian data
DEFINITION OF VOLUME
Figure 5.9 and Figure 5.10 illustrate that only 5 hospitals and 4 surgeons had an annual
volume of at least 11 procedures which is the cut off defined by the US AHRQ and the
US Leapfrog Group. 29, 126 Topal et al. found that only 7 out of 126 Belgian hospitals
annually performed more than 10 pancreaticoduodenectomies between 2000 and
2004. 156 These high-volume hospitals accounted for 43.2% of patients. Topal et al. did
not find apparent changes with regard to the annual number of PDs per hospital over
the five years.
OUTCOME
In this KCE study (see Table 5.25), in-hospital and approximate 30-day mortality is 8.3%
after pancreatectomy for peripancreatic cancer. Table 5.32 compares this Belgian
outcome data with those published in the studies that were selected. Most authors used
the Whipple procedure as only selection criteria. 117, 156, 162, 167 Only a few used a patient
selection which was similar to ours i.e. pancreatectomy together with the diagnosis of
(peri)pancreatic cancer. 155, 175 Regardless of patient selection, short-term mortality rate
always fluctuated between 8 and 10%. None of these studies provided information on
one- or two-year survival.