Abstract
BACKGROUND: Centralization and certification mark constant processes in everyday clinical routine. Despite the continuously rising number of certified pancreatic cancer (PAC) centers in recent years, fewer than 40% of PAC resections are still performed in certified institutions nationwide. The main objective of the certification is the enhancement of patient survival. Furthermore, certification is intended to improve structural quality, multidisciplinary cooperation, and the transparency of treatment pathways. In addition, it should have a positive effect on patient satisfaction. However, it requires the substantial effort of all partners involved. We aim to illustrate both advantages and limitations of the certification process. METHODS: We analyzed perioperative outcomes of patients undergoing pancreatic resection for PAC (ICD C25) before and after our center's first certification, and benchmarked these results against national data from the German Cancer Society. In addition, we analyzed quality of life (QoL) longitudinally using the validated QLQ-C30 questionnaire administered preoperatively and at 1, 4, and 18 months postoperatively. RESULTS: The study cohort included 47 patients treated in the three years prior to certification and 130 patients during the subsequent seven years as a certified center. The mean annual number of PAC resections increased from 15 (ranged 14-18) to 19 (ranged 10-26). In-hospital mortality, length of stay, and rate of exploration-only procedures remained unchanged. Indicators of procedural quality, such as the number of harvested lymph nodes (p = 0.1485) and the precision of histopathological assessment, improved slightly but not significantly. QoL scores generally improved after discharge in both groups; however, functional scales and symptom measures demonstrated unexpectedly inferior values following certification, possibly reflecting higher case complexity. CONCLUSION: Achieving and maintaining certification requires substantial and continuous effort from all disciplines involved. While major improvements in morbidity, mortality, and long-term QoL were not observed, certification ensured clearer delegation of responsibilities, standardized documentation, and structured quality control. We therefore consider the certification process valuable for promoting multidisciplinary collaboration, maintaining high treatment volumes, and ensuring transparent oncological care pathways.