This retrospective multicentre study evaluated short-term outcomes of PDAC surgery across 29 Italian centers (2018–2021), stratified by annual pancreatic surgical volume: low (1–10), medium (11–50), high (51–100), and very-high (>100 cases/year). The primary outcome was 90-day postoperative mortality among resected patients (n=3,134).
90-day mortality fell with increasing volume: 10% (low), 5.3% (medium), 5.1% (high), and 3.4% (very-high). Overall resection rate was 90.7%. Preoperative histological diagnosis was obtained in only 23.3% of cases at high-volume centers vs. 66.6% at very-high-volume centers, revealing major practice gaps beyond volume alone. About 21.5% of patients were treated at centers not meeting national accreditation minimums.
Retrospective design limits causal inference. Only 29 centers participated, which may not represent all Italian PDAC surgical centers. Long-term survival outcomes were not reported.
Volume alone does not ensure quality — even high-volume centers (51–100 cases/year) had >5% 90-day mortality and low rates of preoperative tissue diagnosis. Centralizing PDAC surgery to accredited very-high-volume centers (>100 cases/year) and improving preoperative diagnostic workup are both actionable priorities.
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