Volume is not the only factor: Benchmarking oncologic pancreatic resections in a Peripheral French Center

To evaluate oncologic and postoperative outcomes of pancreatic resections in a French low-volume peripheral center and compare them with national benchmarks from high-volume institutions. The objective was to determine whether a non-centralized center with an experienced hepatobiliary-pancreatic (HPB) team could achieve results comparable to national standards for pancreatic ductal adenocarcinoma (PDAC).

We conducted a retrospective study of 181 consecutive pancreatic resections performed between 2019 and 2024. Eighty-five patients had PDAC. Outcomes for this subgroup were benchmarked against national data reported by Marchese et al. on 17,183 PDAC pancreatectomies. Perioperative management and outcome definitions followed international guidelines.

Despite a high-risk PDAC population (52.8% aged ≥70 years; 85.8% with Charlson Age-Comorbidity Index ≥4), 90-day and 1-year mortality were 3.5% and 10.6%, respectively, both lower than national averages for high-volume centers (4.6% and 18.6%). Clinically relevant postoperative pancreatic fistula occurred in 7.8% of PDAC patients, and 10.5% required reoperation. On multivariable analysis, soft pancreatic texture was the only independent predictor of fistula, while reoperation was strongly associated with early mortality.

Favorable outcomes in pancreatic cancer surgery can be achieved outside high-volume institutions when care is provided by HBP-experienced teams within structured, multidisciplinary pathways. These results support the concept that surgical performance reflects a combination of expertise, organization, and governance rather than volume alone. Adoption of performance-based indicators, alongside volume metrics, may better capture quality and ensure equitable, high-standard care across diverse healthcare settings.