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Kotecha K, Tree K, Ziaziaris WA, McKay SC, Wand H, Samra J, Mittal A. Centralization of Pancreaticoduodenectomy: A Systematic Review and Spline Regression Analysis to Recommend Minimum Volume for a Specialist Pancreas Service. Ann Surg 2024; 279:953-960. [PMID: 38258578 DOI: 10.1097/sla.0000000000006208] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 01/24/2024]
Abstract
OBJECTIVE Through a systematic review and spline curve analysis, to better define the minimum volume threshold for hospitals to perform (pancreaticoduodenectomy) and the high-volume center. BACKGROUND The pancreaticoduodenectomy (PD) is a resource-intensive procedure, with high morbidity and long hospital stays resulting in centralization towards high-volume hospitals; the published definition of high volume remains variable. MATERIALS AND METHODS Following a systematic review of studies comparing PD outcomes across volume groups, semiparametric regression modeling of morbidity (%), mortality (%), length of stay (days), lymph node harvest (number of nodes), and cost ($USD) as continuous variables were performed and fitted as a smoothed function of splines. If this showed a nonlinear association, then a "zero-crossing" technique was used, which produced "first and second derivatives" to identify volume thresholds. RESULTS Our analysis of 33 cohort studies (198,377 patients) showed 55 PDs/year and 43 PDs/year were the threshold value required to achieve the lowest morbidity and highest lymph node harvest, with model estimated df 5.154 ( P <0.001) and 8.254 ( P <0.001), respectively. The threshold value for mortality was ~45 PDs/year (model 9.219 ( P <0.001)), with the lowest mortality value (the optimum value) at ~70 PDs/year (ie, a high-volume center). No significant association was observed for cost ( edf =2, P =0.989) and length of stay ( edf =2.04, P =0.099). CONCLUSIONS There is a significant benefit from the centralization of PD, with 55 PDs/year and 43 PDs/year as the threshold value required to achieve the lowest morbidity and highest lymph node harvest, respectively. To achieve mortality benefit, the minimum procedure threshold is 45 PDs/year, with the lowest and optimum mortality value (ie, a high-volume center) at approximately 70 PDs/year.
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Affiliation(s)
- Krishna Kotecha
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Kevin Tree
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
| | - William A Ziaziaris
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
| | - Siobhan C McKay
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Institute of Cancer and Genomic Science, University of Birmingham, Edgbaston, Birmingham United Kingdom
| | - Handan Wand
- Kirby Institute (formerly National Center in HIV Epidemiology and Clinical Research), University of New South Wales, Sydney, NSW
| | - Jaswinder Samra
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Australian Pancreatic Center, Sydney, Australia
| | - Anubhav Mittal
- Department of Upper Gastrointestinal Surgery, Royal North Shore Hospital, Sydney, New South Wales, Australia
- Northern Clinical School, The University of Sydney, Sydney, New South Wales, Australia
- Australian Pancreatic Center, Sydney, Australia
- University of Notre Dame, Sydney
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Dincer HA, Cennet Ö, Dogrul AB. Comparison of Educational and Academic Quality of Laparoscopic Distal Pancreatectomy Videos on WebSurg ® and YouTube ® Platforms. Surg Innov 2023; 30:728-738. [PMID: 37867402 DOI: 10.1177/15533506231208583] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 10/24/2023]
Abstract
BACKGROUND The aim of this study was to compare the educational and academic quality of laparoscopic distal pancreatectomy (LDP) videos on YouTube® and WebSurg® platforms. MATERIAL AND METHODS YouTube and WebSurg platforms were searched with the keyword "laparoscopic distal pancreatectomy". According to the exclusion criteria, 12 videos were found on WebSurg. To ensure a 1:1 ratio, the first 12 videos that met the criteria on YouTube were also analyzed. Journal of American Medical Association (JAMA) benchmark criteria were used to evaluate the reliability of the videos. The non-educational quality of the videos was calculated using the Global Quality Score (GQS), the educational and academic quality of videos was calculated using Laparoscopic Distal Pancreatectomy-specific score (LDP-SS) and Laparoscopic Surgery Video Educational Guidelines scoring system (LAP-VEGaS). RESULTS The mean JAMA score was 1.58 on YouTube and 2.83 on WebSurg (P < .001). The median GQS was 2 on YouTube and 5 on WebSurg (P < .001). The median LAP-VEGaS score was 8 on YouTube and 14.5 on WebSurg (P < .001). The median LDP-SS score was 6 on YouTube and 9.5 on WebSurg (P = .001). According to the LAP-VEGaS, eleven (91.7%) of the WebSurg videos had a high score of 11 or more (P = .04). According to Spearman correlation analysis, there was a statistically significant positive correlation between LDP-SS and JAMA, GQS and LAP-VEGaS (r: .589, P = .002; r: .648, P = .001; r: .848, P < .001 respectively). CONCLUSIONS The WebSurg is superior to the YouTube in terms of educational and academic value, quality, accuracy, reliability and usability in scientific meetings for LDP videos.
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Affiliation(s)
- Hilmi Anil Dincer
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ömer Cennet
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
| | - Ahmet Bulent Dogrul
- Department of General Surgery, Faculty of Medicine, Hacettepe University, Ankara, Turkey
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Guarga L, Paco N, Manchon-Walsh P, Vela E, Delgadillo J, Pontes C, Borràs JM. Management, Survival, and Costs of Pancreatic Cancer: Population-Based Observational Study in Catalonia. INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2023; 20:ijerph20095673. [PMID: 37174192 PMCID: PMC10177886 DOI: 10.3390/ijerph20095673] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Subscribe] [Scholar Register] [Received: 03/07/2023] [Revised: 04/11/2023] [Accepted: 04/26/2023] [Indexed: 05/15/2023]
Abstract
AIM Few published studies comprehensively describe the characteristics of patients with pancreatic cancer and their treatment in clinical practice. This study aimed to describe the current clinical practice for treating pancreatic cancer in Catalonia, along with the associated survival and treatment costs. METHODS A retrospective observational cohort study in patients diagnosed with pancreatic cancer from 2014 to 2018, using data from the healthcare records of the Public Health System of Catalonia, was conducted. Treatment patterns and costs were described by age groups from 2014 to 2018, with survival reported until December 2021. RESULTS The proportion of patients receiving surgery with curative intent was low, especially in older patients (23% of patients <60 years and 9% of patients ≥80 years). The percentage of patients treated with drugs for unresectable disease also decreased with age (45% of patients <60 years and 8% of patients ≥80 years). Although age was associated with significant differences in survival after curative surgery, no differences attributable to age were observed in patients who received pharmacological treatment for unresectable disease. In patients under 60 years of age, the mean cost of the first year of treatment was EUR 17,730 (standard deviation [SD] 5754) in those receiving surgery and EUR 5398 (SD 9581) in those on pharmacological treatment for unresectable disease. In patients over 80, the mean costs were EUR 15,339 (SD 2634) and EUR 1845 (SD 3413), respectively. CONCLUSIONS Half of the patients diagnosed with pancreatic cancer did not receive specific treatment. Surgery with curative intent was associated with longer survival, but only 18% of (mostly younger) patients received this treatment. Chemotherapy was also used less frequently in patients of advanced age, though survival in treated patients was comparable across all age groups, so careful oncogeriatric assessment is advisable to ensure the most appropriate indication for eligibility in older patients. In general, earlier diagnosis and more effective pharmacological treatments are necessary to treat frail patients with high comorbidity, a common profile in older patients.
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Affiliation(s)
- Laura Guarga
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics, and Toxicology, Autonomous University of Barcelona, 08193 Barcelona, Spain
| | - Noelia Paco
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain
| | - Paula Manchon-Walsh
- Catalan Cancer Plan, Department of Health, Hospitalet del Llobregat, 08908 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
| | - Emili Vela
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
| | | | - Caridad Pontes
- Catalan Health Service (CatSalut), 08007 Barcelona, Spain
- Department of Pharmacology, Therapeutics, and Toxicology, Autonomous University of Barcelona, 08193 Barcelona, Spain
- Digitalization for the Sustainability of the Healthcare System (DS3), Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
| | - Josep Maria Borràs
- Catalan Cancer Plan, Department of Health, Hospitalet del Llobregat, 08908 Barcelona, Spain
- Bellvitge Biomedical Research Institute (IDIBELL), 08006 Barcelona, Spain
- Clinical Sciences Department, University of Barcelona, Campus de Bellvitge, 08907 Barcelona, Spain
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Negoita SI, Ionescu RV, Zlati ML, Antohi VM, Nechifor A. New Regional Dynamic Cancer Model across the European Union. Cancers (Basel) 2023; 15:cancers15092545. [PMID: 37174011 PMCID: PMC10177237 DOI: 10.3390/cancers15092545] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 01/30/2023] [Revised: 04/23/2023] [Accepted: 04/27/2023] [Indexed: 05/15/2023] Open
Abstract
BACKGROUND Can increasing levels of economic wealth significantly influence changes in cancer incidence and mortality rates? METHODS We investigated this issue by means of regression analyses based on the study of incidence and mortality indicators for lip, oral cavity, and pharyngeal; colon; pancreatic; lung; leukaemia; brain and central nervous system cancers in correlation with the levels of economic welfare and financial allocations to health at the level of the European Union member states, with the exception of Luxembourg and Cyprus for which there are no official statistical data reported. RESULTS The results of the study showed that there were significant disparities both regionally and by gender, requiring corrective public policy measures that were formulated in this study. CONCLUSIONS The conclusions highlight the main findings of the study in terms of the evolution of the disease, present the significant aspects that characterise the evolution of each type of cancer during the period analysed (1993-2021), and highlight the novelty and limitations of the study and future directions of research. As a result, increasing economic welfare is a potential factor in halting the effects of cancer incidence and mortality at the population level, while the financial allocations to health of EU member countries' budgets are a drawback due to large regional disparities.
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Affiliation(s)
- Silvius Ioan Negoita
- Anaesthesia Intensive Care Unit, Department Orthopedics, University of Medicine and Pharmacy Carol Davila of Bucharest, 020021 Bucharest, Romania
| | - Romeo Victor Ionescu
- Department of Administrative Sciences and Regional Studies, Dunarea de Jos University of Galati, 800008 Galati, Romania
| | - Monica Laura Zlati
- Department of Business Administration, Dunarea de Jos University of Galati, 800008 Galati, Romania
| | - Valentin Marian Antohi
- Department of Business Administration, Dunarea de Jos University of Galati, 800008 Galati, Romania
- Departament of Finance, Accounting and Economic Theory, Transilvania University of Brasov, 500036 Galati, Romania
| | - Alexandru Nechifor
- Department of Medical Clinical, Dunarea de Jos University of Galati, 800008 Galati, Romania
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Erözkan K, Culcu S, Tamam S, Unal AE. The contribution of laparoscopic distal pancreatectomy videos on YouTube to the learning curve in the COVID-19 pandemic. Medicine (Baltimore) 2022; 101:e31537. [PMID: 36451455 PMCID: PMC9704872 DOI: 10.1097/md.0000000000031537] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Indexed: 12/02/2022] Open
Abstract
There is no standardization in videos uploaded to Youtube. Were the videos capable of contributing to adequate technical quality and surgical training? We are aiming to answer these questions in this paper. It is a cross-sectional study. In January 2022, we searched the Youtube platform using the keyword "distal pancreatectomy." The substantiality, transparency, reliability, quality, popularity and educational values of the video content were evaluated after exclusion criteria. These parameters were evaluated using we the modified Journal of American Medical Association benchmark criteria, Global Quality Score (GQS), Video Power Index, modified laparoscopic pancreatectomy scoring system. The videos uploaded after the pandemic had a statistically significant higher GQS score (P < .001). Video Power Index, like GQS, had a statistically significant difference before and after the pandemic. (P = .046). There was no significant difference in the evaluation of the reliability and substantiality. Until the development of Youtube videos is completed, peer-reviewed, more reliable and content-rich online education platforms should be preferred in the first place. Care should be taken to watch selected videos on Youtube videos.
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Affiliation(s)
- Kamil Erözkan
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
- * Correspondence: Kamil Erozkan, Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey (e-mail: )
| | - Serdar Culcu
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
| | - Selim Tamam
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
| | - Ali Ekrem Unal
- Division of Surgical Oncology, Department of Surgery, Ankara University Cebeci Hospital, Ankara University School of Medicine, Ankara, Turkey
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Manchon-Walsh P, Aliste L, Borràs JM, Coll-Ortega C, Casacuberta J, Casanovas-Guitart C, Clèries M, Cruz S, Guarga À, Mompart A, Planella A, Pozuelo A, Ticó I, Vela E, Prades J. Socioeconomic Status and Distance to Reference Centers for Complex Cancer Diseases: A Source of Health Inequalities? A Population Cohort Study Based on Catalonia (Spain). INTERNATIONAL JOURNAL OF ENVIRONMENTAL RESEARCH AND PUBLIC HEALTH 2022; 19:8814. [PMID: 35886665 PMCID: PMC9322195 DOI: 10.3390/ijerph19148814] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Download PDF] [Figures] [Subscribe] [Scholar Register] [Received: 06/13/2022] [Revised: 07/13/2022] [Accepted: 07/15/2022] [Indexed: 12/10/2022]
Abstract
The centralization of complex surgical procedures for cancer in Catalonia may have led to geographical and socioeconomic inequities. In this population-based cohort study, we assessed the impacts of these two factors on 5-year survival and quality of care in patients undergoing surgery for rectal cancer (2011-12) and pancreatic cancer (2012-15) in public centers, adjusting for age, comorbidity, and tumor stage. We used data on the geographical distance between the patients' homes and their reference centers, clinical patient and treatment data, income category, and data from the patients' district hospitals. A composite 'textbook outcome' was created from five subindicators of hospitalization. We included 646 cases of pancreatic cancer (12 centers) and 1416 of rectal cancer (26 centers). Distance had no impact on survival for pancreatic cancer patients and was not related to worse survival in rectal cancer. Compared to patients with medium-high income, the risk of death was higher in low-income patients with pancreatic cancer (hazard ratio (HR) 1.46, 95% confidence interval (CI) 1.15-1.86) and very-low-income patients with rectal cancer (HR 5.14, 95% CI 3.51-7.52). Centralization was not associated with worse health outcomes in geographically dispersed patients, including for survival. However, income level remained a significant determinant of survival.
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Affiliation(s)
- Paula Manchon-Walsh
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Luisa Aliste
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Josep M. Borràs
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
| | - Cristina Coll-Ortega
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
| | - Joan Casacuberta
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Cristina Casanovas-Guitart
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Montse Clèries
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Sergi Cruz
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Àlex Guarga
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Anna Mompart
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Antoni Planella
- Subdirectorate-General for the Service Portfolio and Health Map, Directorate-General for Health Planning, Department of Health, Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (S.C.); (A.M.); (A.P.)
| | - Alfonso Pozuelo
- Health Service Procurement and Assessment, Catalonian Health Service (CatSalut), Government of Catalonia, Travessera de les Corts, 131-159, 08028 Barcelona, Spain; (C.C.-G.); (À.G.); (A.P.)
| | - Isabel Ticó
- Cartographic and Geological Institute of Catalonia, Parc de Montjuïc, 08038 Barcelona, Spain; (J.C.); (I.T.)
| | - Emili Vela
- Healthcare Information and Knowledge Unit, Department of Health, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain; (M.C.); (E.V.)
- Digitalization for the Sustainability of the Healthcare System (DS3), Sistema de Salut de Catalunya, Government of Catalonia, Gran Via de les Corts Catalanes, 591, 08007 Barcelona, Spain
| | - Joan Prades
- Catalonian Cancer Strategy, Department of Health, Government of Catalonia, Avenida Gran Via de l’Hospitalet, 199-203, 08908 L’Hospitalet de Llobregat, Spain; (L.A.); (J.M.B.); (C.C.-O.); (J.P.)
- Biomedical Research Institute of Bellvitge (IDIBELL), University of Barcelona, C/Feixa Llarga, s/n, 08907 L’Hospitalet de Llobregat, Spain
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