A narrative review: has regionalization truly achieved its intended goal in the surgical management of pancreatic cancer?

Objective: The purpose of this narrative review is to present the data to date on the volume-outcome association in pancreas cancer surgery and describe the prevalence of and barriers to regionalized pancreas cancer care in western health systems. Background: Numerous studies have demonstrated an association between increasing hospital or surgeon volume and improved patient morbidity and mortality in patients undergoing surgery for pancreas cancer. However, since the initial promotion of minimum volume standards, regionalization has remained difficult to establish. Methods: A PubMed literature search for years 1995-2020 was conducted to target original research on the volume-outcome association in pancreas cancer and the prevalence of associated regionalized care systems. Peer reviewed original research studies were selected based on their study design and potential to inform meaningful conclusions from the data. Conclusions: Increasing hospital or surgeon volume is associated with improved short and long-term survival in pancreas cancer patients undergoing surgical resection. Despite the knowledge that increasing hospital and surgeon volume is associated with improved operative mortality and long term survival in pancreas cancer, the majority of patients undergo surgery at low volume hospitals with low volume surgeons. Barriers to regionalization are complex and involve the interaction of many conflicting factors and processes on human, health system, and national levels. Better understanding of the barriers to regionalization in pancreas cancer care is needed before this model of care becomes feasible.