{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,3,25]],"date-time":"2026-03-25T02:35:36Z","timestamp":1774406136241,"version":"3.50.1"},"reference-count":47,"publisher":"MDPI AG","issue":"11","license":[{"start":{"date-parts":[[2025,10,31]],"date-time":"2025-10-31T00:00:00Z","timestamp":1761868800000},"content-version":"vor","delay-in-days":0,"URL":"https:\/\/creativecommons.org\/licenses\/by\/4.0\/"}],"content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["Diseases"],"abstract":"<jats:p>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\u2019s 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\u201318) to 19 (ranged 10\u201326). 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.<\/jats:p>","DOI":"10.3390\/diseases13110353","type":"journal-article","created":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T14:40:48Z","timestamp":1762180848000},"page":"353","update-policy":"https:\/\/doi.org\/10.3390\/mdpi_crossmark_policy","source":"Crossref","is-referenced-by-count":1,"title":["Impact of Becoming a Certified Oncologic Center of Pancreatic Surgery: Evaluation of Single-Center Perioperative Results and Quality of Life Before and After Implementation of a Certified Center"],"prefix":"10.3390","volume":"13","author":[{"ORCID":"https:\/\/orcid.org\/0000-0002-8845-6832","authenticated-orcid":false,"given":"Jan-Paul","family":"Gundlach","sequence":"first","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3 (Building C), 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thorben","family":"Fedders","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3 (Building C), 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0001-7002-1462","authenticated-orcid":false,"given":"Steffen Markus","family":"Heckl","sequence":"additional","affiliation":[{"name":"Department of Internal Medicine II, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"given":"Thomas","family":"Becker","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3 (Building C), 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]},{"ORCID":"https:\/\/orcid.org\/0000-0002-5695-5442","authenticated-orcid":false,"given":"Julius","family":"Pochhammer","sequence":"additional","affiliation":[{"name":"Department of General, Visceral-, Thoracic-, Transplantation- and Pediatric Surgery, University Medical Center Schleswig-Holstein (UKSH), Campus Kiel, Arnold-Heller-Strasse 3 (Building C), 24105 Kiel, Germany"}],"role":[{"role":"author","vocabulary":"crossref"}]}],"member":"1968","published-online":{"date-parts":[[2025,10,31]]},"reference":[{"key":"ref_1","doi-asserted-by":"crossref","first-page":"712","DOI":"10.1097\/SLA.0000000000002965","article-title":"Toward a Consensus on Centralization in Surgery","volume":"268","author":"Vonlanthen","year":"2018","journal-title":"Ann. Surg."},{"key":"ref_2","doi-asserted-by":"crossref","first-page":"2081","DOI":"10.1007\/s11605-019-04215-y","article-title":"Centralization of Pancreatic Surgery in Europe","volume":"23","author":"Polonski","year":"2019","journal-title":"J. Gastrointest. Surg."},{"key":"ref_3","doi-asserted-by":"crossref","first-page":"49","DOI":"10.1111\/j.1477-2574.2012.00571.x","article-title":"A contemporary analysis of survival for resected pancreatic ductal adenocarcinoma","volume":"15","author":"Lewis","year":"2013","journal-title":"HPB"},{"key":"ref_4","doi-asserted-by":"crossref","first-page":"e476","DOI":"10.1016\/S1470-2045(13)70172-4","article-title":"Improvement of surgical results for pancreatic cancer","volume":"14","author":"Hartwig","year":"2013","journal-title":"Lancet Oncol."},{"key":"ref_5","doi-asserted-by":"crossref","first-page":"11","DOI":"10.1038\/s41571-018-0112-1","article-title":"Optimizing the outcomes of pancreatic cancer surgery","volume":"16","author":"Strobel","year":"2019","journal-title":"Nat. Rev. Clin. Oncol."},{"key":"ref_6","doi-asserted-by":"crossref","unstructured":"Kowalski, C., Graeven, U., von Kalle, C., Lang, H., Beckmann, M.W., Blohmer, J.U., Burchardt, M., Ehrenfeld, M., Fichtner, J., and Grabbe, S. (2017). Shifting cancer care towards Multidisciplinarity: The cancer center certification program of the German cancer society. BMC Cancer, 17.","DOI":"10.1186\/s12885-017-3824-1"},{"key":"ref_7","unstructured":"Deutsche Krebsgesellschaft, e.V., Zertifizierungskommission Viszeralonkologische Zentren\/Pankreaskarzinomzentren, Mayerle, J., Rei\u00dffelder, C., Wesselmann, S., R\u00fcckher, J., Utzig, M., Barth, C., and Dudu, F. (2025). Jahresbericht der Zertifizierten Pankreaskarzinomzentren. Auditjahr 2024\/Kennzahlenjahr 2023, Deutsche Krebsgesellschaft (DKG)."},{"key":"ref_8","unstructured":"Deutsche Krebsgesellschaft, e.V., Zertifizierungskommission Viszeralonkologische Zentren\/Pankreaskarzinomzentren, Seufferlein, T., Post, S., Wesselmann, S., R\u00fcckher, J., Rommel, M., Dudu, F., and Ferencz, J. (2021). Jahresbericht der Zertifizierten Pankreaskarzinomzentren. Auditjahr 2020\/Kennzahlenjahr 2019, Deutsche Krebsgesellschaft (DKG)."},{"key":"ref_9","doi-asserted-by":"crossref","first-page":"47","DOI":"10.1007\/s00104-018-0654-x","article-title":"Investigations on in-hospital mortality in pancreatic surgery: Results of a multicenter observational study","volume":"90","author":"Gastinger","year":"2019","journal-title":"Chirurg"},{"key":"ref_10","doi-asserted-by":"crossref","unstructured":"Krautz, C., Haase, E., Elshafei, M., Saeger, H.D., Distler, M., Grutzmann, R., and Weber, G.F. (2019). The impact of surgical experience and frequency of practice on perioperative outcomes in pancreatic surgery. BMC Surg., 19.","DOI":"10.1186\/s12893-019-0577-6"},{"key":"ref_11","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1016\/j.surg.2021.03.023","article-title":"Long-term quality of life and global health following pancreatic surgery for benign and malignant pathologies","volume":"170","author":"Shaw","year":"2021","journal-title":"Surgery"},{"key":"ref_12","doi-asserted-by":"crossref","first-page":"204","DOI":"10.1016\/j.hpb.2017.11.002","article-title":"Systematic review on the impact of pancreatoduodenectomy on quality of life in patients with pancreatic cancer","volume":"20","author":"Heerkens","year":"2018","journal-title":"HPB"},{"key":"ref_13","doi-asserted-by":"crossref","unstructured":"Waldmann, A., Schubert, D., and Katalinic, A. (2013). Normative data of the EORTC QLQ-C30 for the German population: A population-based survey. PLoS ONE, 8.","DOI":"10.1371\/journal.pone.0074149"},{"key":"ref_14","doi-asserted-by":"crossref","first-page":"566","DOI":"10.1245\/s10434-007-9615-1","article-title":"Impact of the site of anastomosis after oncologic esophagectomy on quality of life--a prospective, longitudinal outcome study","volume":"15","author":"Egberts","year":"2008","journal-title":"Ann. Surg. Oncol."},{"key":"ref_15","first-page":"8","article-title":"Surgical outcome of pancreaticoduodenectomy: High volume center or multidisciplinary management?","volume":"71","author":"Alemanno","year":"2016","journal-title":"Minerva Chir."},{"key":"ref_16","first-page":"753","article-title":"Certified stomach cancer centres as seen by their directors: Results of a questionaire to key personnel","volume":"50","author":"Huthmann","year":"2012","journal-title":"Z. Gastroenterol."},{"key":"ref_17","doi-asserted-by":"crossref","first-page":"711","DOI":"10.1016\/j.suc.2013.02.010","article-title":"The economics of pancreas surgery","volume":"93","author":"Vollmer","year":"2013","journal-title":"Surg. Clin. N. Am."},{"key":"ref_18","doi-asserted-by":"crossref","first-page":"126","DOI":"10.1159\/000456045","article-title":"Quality Indicators in Pancreatic Surgery: Lessons Learned from the German DGAV StuDoQ|Pancreas Registry","volume":"33","author":"Wellner","year":"2017","journal-title":"Visc. Med."},{"key":"ref_19","doi-asserted-by":"crossref","first-page":"32","DOI":"10.1007\/s00104-017-0564-3","article-title":"Quality indicators for pancreatic surgery: Scientific derivation and clinical relevance","volume":"89","author":"Wellner","year":"2018","journal-title":"Chirurg"},{"key":"ref_20","doi-asserted-by":"crossref","first-page":"456","DOI":"10.1007\/s00268-013-2283-3","article-title":"Preparing for prospective clinical trials: A national initiative of an excellence registry for consecutive pancreatic cancer resections","volume":"38","author":"Gangl","year":"2014","journal-title":"World J. Surg."},{"key":"ref_21","doi-asserted-by":"crossref","first-page":"747","DOI":"10.1002\/bjs.11085","article-title":"Variation in pancreatoduodenectomy as delivered in two national audits","volume":"106","author":"Mackay","year":"2019","journal-title":"Br. J. Surg."},{"key":"ref_22","doi-asserted-by":"crossref","first-page":"1069","DOI":"10.1016\/j.ejso.2019.01.018","article-title":"Determining the optimal number of examined lymph nodes for accurate staging of pancreatic cancer: An analysis using the nodal staging score model","volume":"45","author":"Hua","year":"2019","journal-title":"Eur. J. Surg. Oncol."},{"key":"ref_23","doi-asserted-by":"crossref","first-page":"e554","DOI":"10.1097\/SLA.0000000000003558","article-title":"Significance of Examined Lymph Node Number in Accurate Staging and Long-term Survival in Resected Stage I-II Pancreatic Cancer-More is Better? A Large International Population-based Cohort Study","volume":"274","author":"Huang","year":"2021","journal-title":"Ann. Surg."},{"key":"ref_24","doi-asserted-by":"crossref","first-page":"748","DOI":"10.1097\/MPA.0000000000000540","article-title":"Microscopic Residual Tumor After Pancreaticoduodenectomy: Is Standardization of Pathological Examination Worthwhile?","volume":"45","author":"Borzomati","year":"2016","journal-title":"Pancreas"},{"key":"ref_25","doi-asserted-by":"crossref","first-page":"1111","DOI":"10.1111\/j.1365-2559.2011.04056.x","article-title":"Tumour growth is more dispersed in pancreatic head cancers than in rectal cancer: Implications for resection margin assessment","volume":"59","author":"Verbeke","year":"2011","journal-title":"Histopathology"},{"key":"ref_26","doi-asserted-by":"crossref","first-page":"2855","DOI":"10.1200\/JCO.2008.20.5104","article-title":"Margin clearance and outcome in resected pancreatic cancer","volume":"27","author":"Chang","year":"2009","journal-title":"J. Clin. Oncol."},{"key":"ref_27","doi-asserted-by":"crossref","first-page":"1551","DOI":"10.1002\/bjs.9919","article-title":"Postoperative infectious complications after pancreatic resection","volume":"102","author":"Okano","year":"2015","journal-title":"Br. J. Surg."},{"key":"ref_28","doi-asserted-by":"crossref","first-page":"547","DOI":"10.1007\/s00423-013-1076-3","article-title":"Early and late postoperative changes in the quality of life after pancreatic surgery","volume":"398","author":"Belyaev","year":"2013","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_29","doi-asserted-by":"crossref","first-page":"257","DOI":"10.1002\/bjs.10032","article-title":"Health-related quality of life after pancreatic resection for malignancy","volume":"103","author":"Heerkens","year":"2016","journal-title":"Br. J. Surg."},{"key":"ref_30","doi-asserted-by":"crossref","first-page":"445","DOI":"10.1016\/j.pan.2017.02.013","article-title":"Quality of life in patients with pancreatic ductal adenocarcinoma undergoing pancreaticoduodenectomy","volume":"17","author":"Laitinen","year":"2017","journal-title":"Pancreatology"},{"key":"ref_31","first-page":"387","article-title":"Impact of post-operative complications on quality of life after pancreatectomy","volume":"13","author":"Mbah","year":"2012","journal-title":"JOP"},{"key":"ref_32","doi-asserted-by":"crossref","first-page":"1099","DOI":"10.1002\/bjs.5371","article-title":"Quality of life after pancreaticoduodenectomy for ductal adenocarcinoma of the pancreatic head","volume":"93","author":"Schniewind","year":"2006","journal-title":"Br. J. Surg."},{"key":"ref_33","doi-asserted-by":"crossref","first-page":"341","DOI":"10.1007\/s11605-018-04102-y","article-title":"Randomized Trial of Pylorus-Preserving vs. Pylorus-Resecting Pancreatoduodenectomy: Long-Term Morbidity and Quality of Life","volume":"24","author":"Klaiber","year":"2020","journal-title":"J. Gastrointest. Surg."},{"key":"ref_34","first-page":"CD006053","article-title":"Pylorus-preserving pancreaticoduodenectomy (pp Whipple) versus pancreaticoduodenectomy (classic Whipple) for surgical treatment of periampullary and pancreatic carcinoma","volume":"2","author":"Huttner","year":"2016","journal-title":"Cochrane Database Syst. Rev."},{"key":"ref_35","doi-asserted-by":"crossref","first-page":"189","DOI":"10.1016\/j.jss.2013.10.004","article-title":"Quality of life in patients after total pancreatectomy is comparable with quality of life in patients who undergo a partial pancreatic resection","volume":"187","author":"Epelboym","year":"2014","journal-title":"J. Surg. Res."},{"key":"ref_36","doi-asserted-by":"crossref","first-page":"267","DOI":"10.1001\/jama.297.3.267","article-title":"Adjuvant Chemotherapy With Gemcitabine vs. Observation in Patients Undergoing Curative-Intent Resection of Pancreatic Cancer: A Randomized Controlled Trial","volume":"297","author":"Oettle","year":"2007","journal-title":"JAMA."},{"key":"ref_37","doi-asserted-by":"crossref","first-page":"246","DOI":"10.1038\/sj.bjc.6604838","article-title":"Adjuvant 5-fluorouracil and folinic acid vs. observation for pancreatic cancer: Composite data from the ESPAC-1 and -3(v1) trials","volume":"100","author":"Neoptolemos","year":"2009","journal-title":"Br. J. Cancer"},{"key":"ref_38","doi-asserted-by":"crossref","first-page":"2395","DOI":"10.1056\/NEJMoa1809775","article-title":"FOLFIRINOX or Gemcitabine as Adjuvant Therapy for Pancreatic Cancer","volume":"379","author":"Conroy","year":"2018","journal-title":"N. Engl. J. Med."},{"key":"ref_39","doi-asserted-by":"crossref","first-page":"2456","DOI":"10.1200\/JCO.24.00541","article-title":"Management of Fatigue in Adult Survivors of Cancer: ASCO\u2013Society for Integrative Oncology Guideline Update","volume":"42","author":"Bower","year":"2024","journal-title":"JCO."},{"key":"ref_40","doi-asserted-by":"crossref","first-page":"163","DOI":"10.1186\/s13063-017-1911-x","article-title":"The pancreatic surgery registry (StuDoQ|Pancreas) of the German Society for General and Visceral Surgery (DGAV)\u2014Presentation and systematic quality evaluation","volume":"18","author":"Wellner","year":"2017","journal-title":"Trials"},{"key":"ref_41","doi-asserted-by":"crossref","first-page":"i3571","DOI":"10.1136\/bmj.i3571","article-title":"Surgeon specialization and operative mortality in United States: Retrospective analysis","volume":"354","author":"Sahni","year":"2016","journal-title":"BMJ"},{"key":"ref_42","doi-asserted-by":"crossref","first-page":"917","DOI":"10.1007\/s00423-018-1724-8","article-title":"Neoadjuvant and adjuvant chemotherapy in pancreatic cancer","volume":"403","author":"Klaiber","year":"2018","journal-title":"Langenbecks Arch. Surg."},{"key":"ref_43","doi-asserted-by":"crossref","first-page":"457","DOI":"10.1097\/SLA.0000000000001850","article-title":"Locally Advanced Pancreatic Cancer: Neoadjuvant Therapy With Folfirinox Results in Resectability in 60% of the Patients","volume":"264","author":"Hackert","year":"2016","journal-title":"Ann. Surg."},{"key":"ref_44","doi-asserted-by":"crossref","first-page":"96","DOI":"10.1016\/j.ctrv.2017.03.003","article-title":"The impact of neoadjuvant therapy on the histopathological features of pancreatic ductal adenocarcinoma\u2014A systematic review and meta-analysis","volume":"55","author":"Schorn","year":"2017","journal-title":"Cancer Treat. Rev."},{"key":"ref_45","doi-asserted-by":"crossref","first-page":"515","DOI":"10.1097\/MPA.0000000000000314","article-title":"FOLFIRINOX-based neoadjuvant therapy in borderline resectable or unresectable pancreatic cancer: A meta-analytical review of published studies","volume":"44","author":"Petrelli","year":"2015","journal-title":"Pancreas"},{"key":"ref_46","doi-asserted-by":"crossref","first-page":"302","DOI":"10.1097\/COC.0000000000000278","article-title":"Neoadjuvant Therapy for Pancreatic Cancer: Systematic Review of Postoperative Morbidity, Mortality, and Complications","volume":"39","author":"Verma","year":"2016","journal-title":"Am. J. Clin. Oncol."},{"key":"ref_47","doi-asserted-by":"crossref","first-page":"109500","DOI":"10.3748\/wjg.v31.i26.109500","article-title":"Serum exosomal hsa-let-7f-5p: A potential diagnostic biomarker for metastatic pancreatic cancer detection","volume":"31","author":"Ren","year":"2025","journal-title":"World J. Gastroenterol."}],"container-title":["Diseases"],"original-title":[],"language":"en","link":[{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/11\/353\/pdf","content-type":"unspecified","content-version":"vor","intended-application":"similarity-checking"}],"deposited":{"date-parts":[[2025,11,3]],"date-time":"2025-11-03T15:07:23Z","timestamp":1762182443000},"score":1,"resource":{"primary":{"URL":"https:\/\/www.mdpi.com\/2079-9721\/13\/11\/353"}},"subtitle":[],"short-title":[],"issued":{"date-parts":[[2025,10,31]]},"references-count":47,"journal-issue":{"issue":"11","published-online":{"date-parts":[[2025,11]]}},"alternative-id":["diseases13110353"],"URL":"https:\/\/doi.org\/10.3390\/diseases13110353","relation":{},"ISSN":["2079-9721"],"issn-type":[{"value":"2079-9721","type":"electronic"}],"subject":[],"published":{"date-parts":[[2025,10,31]]}}}