Abstract
BACKGROUND: Although the relationship between higher surgical volume and improved outcomes for pancreatic operations is well established, centralizing care to high-volume centers (HVC) may prolong the interval from diagnosis to surgery. This study sought to compare outcomes of patients who had longer wait times for upfront surgery for pancreatic cancer (PDAC) at HVCs with those of patients who underwent earlier surgery at low-volume centers (LVCs). METHODS: Patients undergoing upfront pancreatic surgery for T1-3N0-2M0 PDAC were identified from the 2004-2023 National Cancer Database. High-volume centers were defined using Leapfrog criteria as centers performing ≥ 20 pancreatic resections/year, with others defined as LVCs. Patients who waited more than 28 days for resection at HVCs were classified as "long wait/high volume," whereas those who underwent surgery in ≤ 14 days at LVCs were classified as "short wait/low volume." RESULTS: Among 15,310 patients meeting the inclusion criteria, 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 (23% vs. 19%, P < 0.001, log-rank). After comprehensive risk adjustment, waiting for surgery at an HVC remained associated with reduced mortality hazard during 5 years of follow-up evaluation (hazard ratio [HR], 0.81; 95% CI, 0.77-0.85; P < 0.001). Considering acute endpoints, the long-wait/high-volume group demonstrated greater likelihood of complete (R0) resection and reduced 30-day mortality, but higher risk of nodal disease and upstaging at resection. CONCLUSION: Waiting for surgery at an HVC is associated with improved acute outcomes and superior overall survival compared with earlier operations at an LVC. These findings assuage concerns regarding the potential longer wait times for surgery associated with centralization of surgical care for PDAC.