Pancreatic cancer surgery in Italy: an updated snapshot from a national multicentre analysis of outcomes by hospital volume

Introduction Although surgical volume has a well-known association with outcomes in pancreatic surgery, volume alone does not necessarily guarantee quality for pancreatic ductal adenocarcinoma (PDAC). The study aimed to provide an overview of current surgical practices and short-term outcomes for PDAC in Italy. Methods A retrospective multicentre study was conducted including all patients who underwent surgery for PDAC at 29 centers between 2018 and 2021. Centers were categorized by annual pancreatic surgical volume as low (1-10), medium (11-50), high (51-100), and very-high (> 100). The primary outcome was 90-day postoperative mortality. Results A total of 3455 patients were included, treated in low-(n = 26), medium-(n = 1103), high-(n = 322), and very-high-volume (n = 2004) centers. The median PDAC-surgeries per year was 27 (IQR 23-28) in high-and 107 (IQR 64-204) in very-high-volume centers. Preoperative histological diagnosis was obtained in 66.6% of cases (n = 1335/2004) in very-high, 45.7% (n = 504/1103) in medium-, and 23.3% (n = 75/322) in high-volume centers. The overall resection rate was 90.7% (n = 3134/3455), while the remainder underwent exploration or palliative surgery. Ninety-day mortality among resected cases was 10% (n = 2/20), 5.3% (n = 51/961), 5.1% (n = 15/294), and 3.4% (n = 63/1859) in low-, medium-, high-, and very-high-volume centers, respectively. Conclusion Considerable heterogeneity persists in PDAC management across Italy. According to the national criteria for the accreditation of Pancreas Units, 21.5% of patients could be treated in centers that fail to meet minimum standards, while an additional 5.9% receive care in high-volume centers where the 90-day mortality still exceeds 5%.