{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,1]],"date-time":"2026-10-01T06:38:53Z","timestamp":1790836733683,"version":"4.1.0"},"reference-count":26,"publisher":"Oxford University Press (OUP)","issue":"10","license":[{"start":{"date-parts":[[2011,6,29]],"date-time":"2011-06-29T00:00:00Z","timestamp":1309305600000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/academic.oup.com\/journals\/pages\/open_access\/funder_policies\/chorus\/standard_publication_model"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":[],"published-print":{"date-parts":[[2011,9,2]]},"abstract":"<jats:title>Abstract<\/jats:title>\n               <jats:sec>\n                  <jats:title>Background<\/jats:title>\n                  <jats:p>High-volume institutions are associated with improved clinical outcomes for pancreatic cancer. This study investigated the impact of centralizing pancreatic cancer surgery in the south of the Netherlands.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Methods<\/jats:title>\n                  <jats:p>All patients diagnosed in the Eindhoven Cancer Registry area in 1995\u20132000 (precentralization) and 2005\u20132008 (implementation of centralization agreements) with primary cancer of the pancreatic head, extrahepatic bile ducts, ampulla of Vater or duodenum were included. Resection rates, in-hospital mortality, 2-year survival and changes in treatment patterns were analysed. Multivariable regression analyses were used to identify independent risk factors for death.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Results<\/jats:title>\n                  <jats:p>Some 2129 patients were identified. Resection rates increased from 19\u00b70 to 30\u00b70 per cent (P &amp;lt; 0\u00b7001). The number of hospitals performing resections decreased from eight to three, and the annual number of resections per hospital increased from two to 16. The in-hospital mortality rate dropped from 24\u00b74 to 3\u00b76 per cent (P &amp;lt; 0\u00b7001) and was zero in 2008. The 2-year survival rate after surgery increased from 38\u00b71 to 49\u00b74 per cent (P = 0\u00b7001), and the rate irrespective of treatment increased from 10\u00b73 to 16\u00b70 per cent (P &amp;lt; 0\u00b7001). There was no improvement in 2-year survival in non-operated patients. After adjustment for relevant patient and tumour factors, those undergoing surgery more recently had a lower risk of death (hazard ratio 0\u00b770, 95 per cent confidence interval 0\u00b751 to 0\u00b797). Changes in surgical patterns seemed largely to explain the improvements.<\/jats:p>\n               <\/jats:sec>\n               <jats:sec>\n                  <jats:title>Conclusion<\/jats:title>\n                  <jats:p>High-quality care can be achieved in regional hospitals through collaboration. Centralization should no longer be regarded as a threat by general hospitals but as a chance to improve outcomes in pancreatic cancer.<\/jats:p>\n               <\/jats:sec>","DOI":"10.1002\/bjs.7581","type":"journal-article","created":{"date-parts":[[2011,6,30]],"date-time":"2011-06-30T15:01:24Z","timestamp":1309446084000},"page":"1455-1462","source":"Crossref","is-referenced-by-count":138,"title":["Improving outcome for patients with pancreatic cancer through centralization"],"prefix":"10.1093","volume":"98","author":[{"given":"V E P P","family":"Lemmens","sequence":"first","affiliation":[{"name":"Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands"},{"name":"Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"K","family":"Bosscha","sequence":"additional","affiliation":[{"name":"Department of Surgery, Jeroen Bosch Hospital, \u2018s-Hertogenbosch, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"G","family":"van der Schelling","sequence":"additional","affiliation":[{"name":"Department of Surgery, Amphia Hospital, Breda, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"S","family":"Brenninkmeijer","sequence":"additional","affiliation":[{"name":"Department of Surgery, TweeSteden Hospital, Tilburg, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"J W W","family":"Coebergh","sequence":"additional","affiliation":[{"name":"Eindhoven Cancer Registry, Comprehensive Cancer Centre South (IKZ), Eindhoven, The Netherlands"},{"name":"Department of Public Health, Erasmus University Medical Centre, Rotterdam, The Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"I H J T","family":"de Hingh","sequence":"additional","affiliation":[{"name":"Department of Surgery, Catharina Hospital, Eindhoven, The 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