Improved survival with delayed surgery at high-volume centers versus early surgery at low-volume centers for pancreatic cancer

Although the relationship between higher surgical voluma and improved outcomes for pancreatic operations is well established, centralizing care to high-volume centers (HVCs; ≥ 20 pancreatic resections per year) may prolong the interval from diagnosis to surgery. A study using the 2004-2023 National Cancer Database compared outcomes of PDAC patients at HVCs with those of patients who underwent earlier surgery at low-volume center (LVCs). Long wait was defined as more than 28 days between diagnosis and surgery. Among 15,310 patients, 9598 (63%) were short wait/low volume and 5712 (37%) were long wait/high volume. In unadjusted analysis, long wait/high volume demonstrated superior 5-year survival compared with short wait/low volume. After comprehensive risk adjustment, waiting for surgery at an HVC remained associated with reduced mortality during 5 years of follow-up (HR 0.81; p<0.001). Considering acute endpoint, the long-wait/high volume group demonstrated greater likelihood of R0 resection and reduced 30-day mortality, but higher risk of nodal disease and upstaging at resection. The authors conclude that waiting for surgery at an HVC is associates with improved outcomes compared with earlier operation at an LVC.