[Skip to Content]
[Skip to Content Landing]
Views 137
Citations 0
Comment & Response
May 27, 2020

Regionalization of Pancreatectomy for Pancreatic Cancer

Author Affiliations
  • 1Department of Gastrointestinal Surgery, Stavanger University Hospital, Stavanger, Norway
  • 2Institute for Clinical Medicine, University of Bergen, Bergen, Norway
JAMA Surg. Published online May 27, 2020. doi:10.1001/jamasurg.2020.0850

To the Editor I read with interest the study by Diaz and Pawlik1 analyzing optimal location centralization of hospitals performing pancreatic resection in California (estimated 40 million inhabitants). The move from more than 100 hospitals to some 9 hospitals would create very high-volume hospitals for pancreatic resection (median >100 resections per year). Investigating data from the same region, others have suggested that centralization would jeopardize access for vulnerable groups (elderly individuals; racial minority groups; and some payer systems) and potentially increase health care disparities.2 Further, the analysis of available resection assumes the optimal number of resections have been reached, but this can only be investigated by evaluation of the resection rates in the population (eg, pancreatectomies per 100 000 inhabitants3,4) or, even more precise, the actual age-adjusted resection rates for pancreatic cancer per se. Are the 1056 resections in year 2016 sufficient for a population of almost 40 million? Have all (potential) resectable cases been given an opportunity to be considered for surgery or seen by an expert multidisciplinary team? With increasing use of neoadjuvant strategies, one must consider the provision of care for borderline and locally advanced cancers because these tumors may be considered irresectable in some but not all centers.5 Notably, patients who are never considered for surgery owing to system barriers have a 100% mortality (for pancreatic cancer), even if resectable. Creating care pathways, ensuring network levels of expertise, and providing access to proper hubs for supraselected situations may avoid sending the patients on an unexpected journey.

Limit 200 characters
Limit 25 characters
Conflicts of Interest Disclosure

Identify all potential conflicts of interest that might be relevant to your comment.

Conflicts of interest comprise financial interests, activities, and relationships within the past 3 years including but not limited to employment, affiliation, grants or funding, consultancies, honoraria or payment, speaker's bureaus, stock ownership or options, expert testimony, royalties, donation of medical equipment, or patents planned, pending, or issued.

Err on the side of full disclosure.

If you have no conflicts of interest, check "No potential conflicts of interest" in the box below. The information will be posted with your response.

Not all submitted comments are published. Please see our commenting policy for details.

Limit 140 characters
Limit 3600 characters or approximately 600 words