Skip to main content
padlock icon - secure page this page is secure

Influence of specialization on the management and outcome of patients with pancreatic cancer

The full text article is not available for purchase.

The publisher only permits individual articles to be downloaded by subscribers.


Cancer care is increasingly specialized. Relationships between pancreatic cancer care, mortality and patterns of clinical practice among the full spectrum of patients, including those with irresectable tumours, are not well understood.


A cohort of 782 patients diagnosed prospectively with pancreatic cancer in 29 acute hospitals in England and Wales over 1 year were followed for 2–3 years. The effects of doctors' and hospitals' specialization, indicated by annual patient volumes, on operative mortality rates, survival times, and test and treatment provision were studied. Multiple logistic and Cox regression models were used to control for prognostic factors and treatments, providing adjusted odds and hazard ratios associated with a higher volume of ten patients annually.


Patients managed by higher-volume hospitals survived significantly longer (hazard ratio 0·88 (95 per cent confidence interval (c.i.) 0·83 to 0·93); P < 0·001). They were more likely to undergo cytological examination (odds ratio (OR) 1·21 (95 per cent c.i. 1·01 to 1·35)), resection (OR 1·44 (1·17 to1·79)) and biliary stenting (OR 1·17 (1·02 to 1·34)), and were less likely to have bypass surgery (OR 0·66 (0·55 to 0·78)). Patients of higher-volume doctors were more likely to undergo endoscopic retrograde cholangiopancreatography (OR 1·59 (1·19 to 2·11)), percutaneous transhepatic cholangiography (OR 1·50 (1·12 to 2·00)), laparoscopy (OR 1·81 (1·07 to 3·06)), resection (OR 1·84 (1·29 to 2·61)) and bypass surgery (1·71 (1·25 to 2·33)).


Specialization appears to improve survival and to promote more thorough investigation. Copyright © 2003 British Journal of Surgery Society Ltd. Published by John Wiley & Sons, Ltd.
No References
No Citations
No Supplementary Data
No Article Media
No Metrics

Document Type: Research Article

Affiliations: 1: Medical Research Council Health Services Research Collaboration, Department of Social Medicine, University of Bristol, Bristol, UK 2: Department of Surgery, University of Bristol, Bristol, UK 3: Department of Social Medicine, University of Bristol, Bristol, UK 4: School of Medicine, Health Policy and Practice, University of East Anglia, Norwich, UK

Publication date: February 1, 2003

More about this publication?
  • Access Key
  • Free content
  • Partial Free content
  • New content
  • Open access content
  • Partial Open access content
  • Subscribed content
  • Partial Subscribed content
  • Free trial content
Cookie Policy
Cookie Policy
Ingenta Connect website makes use of cookies so as to keep track of data that you have filled in. I am Happy with this Find out more