Practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer: A nationwide cohort study

Jesse V. Groen*, Nynke Michiels, the Dutch Pancreatic Cancer Group, Marc G. Besselink, Koop Bosscha, Olivier R. Busch, Ronald van Dam, Casper H.J. van Eijck, Bas Groot Koerkamp, Erwin van der Harst, Ignace H. de Hingh, Tom M. Karsten, Daan J. Lips, Vincent E. de Meijer, Isaac Q. Molenaar, Vincent B. Nieuwenhuijs, Daphne Roos, Hjalmar C. van Santvoort, Jan H. Wijsman, Fennie WitBabs M. Zonderhuis, Judith de Vos-Geelen, Martin N. Wasser, Bert A. Bonsing, Martijn W.J. Stommel, J. Sven D. Mieog

*Corresponding author for this work

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Abstract

Background:

Practice variation exists in venous resection during pancreatoduodenectomy, but little is known about the potential causes and consequences as large studies are lacking. This study explores the potential causes and consequences of practice variation in venous resection during pancreatoduodenectomy for pancreatic cancer in the Netherlands. 

Methods: 

This nationwide retrospective cohort study included patients undergoing pancreatoduodenectomy for pancreatic cancer in 18 centers from 2013 through 2017. 

Results: 

Among 1,311 patients undergoing pancreatoduodenectomy, 351 (27%) had a venous resection, and the overall median annual center volume of venous resection was 4. No association was found between the center volume of pancreatoduodenectomy and the rate of venous resections, nor between patient and tumor characteristics and the rate of venous resections per center. Female sex, lower body mass index, neoadjuvant therapy, venous involvement, and stenosis on imaging were predictive for venous resection. Adjusted for these factors, 3 centers performed significantly more, and 3 centers performed significantly fewer venous resections than expected. In patients with venous resection, significantly less major morbidity (22% vs 38%) and longer overall survival (median 16 vs 12 months) were observed in centers with an above-median annual volume of venous resections (>4). 

Conclusion: 

Patient and tumor characteristics did not explain significant practice variation between centers in the Netherlands in venous resection during pancreatoduodenectomy for pancreatic cancer. The clinical outcomes of venous resection might be related to the volume of the procedure.

Original languageEnglish
Pages (from-to)924-933
Number of pages10
JournalSurgery (United States)
Volume174
Issue number4
Early online date13 Jul 2023
DOIs
Publication statusPublished - Oct 2023

Bibliographical note

Publisher Copyright:
© 2023 The Author(s)

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