Increase in Pancreatoduodenectomy Volume at Mid-Volume Facilities in the United States: A National Cancer Database...

The annual number of pancreatoduodenectomies (PDs) in the United States has increased over the past decade, but the facility types driving this growth and whether outcomes have improved remain unclear. We aimed to identify characteristics of facilities with increasing PD volumes and assess national trends in centralization.

We queried the National Cancer Database to identify PD cases from 2011 to 2020. We categorized facilities by average annual PD volume (low [< 5 cases/year], medium [5-19], and high [≥ 20]) and compared changes in surgical outcomes and other factors over time across facility categories. We used logistic regression to identify factors associated with increasing annual PD volume.

We identified 41 147 PD cases from 810 facilities (589 low-, 171 medium-, 50 high-volume). Overall, the annual PD volume rose from 3217 in 2011 to 4355 in 2020. The increase was primarily due to medium-volume facilities, which performed 903 more cases in 2020 than in 2011 (a 71% increase). Surgical outcomes improved over time across all facility categories, but outcomes at low- and medium-volume facilities remained inferior to those at high-volume facilities. Among medium-volume facilities, the adoption of minimally invasive PD and a higher proportion of PDs for advanced-stage disease were associated with increasing volume.

Medium-volume facilities accounted for most of the recent growth in PD volume in the United States but continued to demonstrate less favorable outcomes than high-volume centers. These findings underscore the importance of continued efforts to promote the outcome-driven centralization of PD to improve surgical outcomes.