Should pancreatic surgery be centralised in France? An evidence-based analysis.

Pancreatic surgery is a complex procedure with considerable postoperative morbidity and mortality. The rates of morbidity and mortality are 50% and 5%, respectively. The consequences of this morbidity extend beyond the postoperative period as it directly affects the survival and recurrence of oncological patients. Several European countries have adopted a policy of pancreatic surgery centralization to improve postoperative outcomes. Previous data from several international registries show a direct correlation between the volume of annual pancreatic surgery and postoperative outcomes. In addition, some studies also show an impact of centralization on the survival of patients who underwent pancreatectomy for pancreatic adenocarcinoma. In France, the thresholds used to define a centre as high volume are both arbitrary and irrelevant. Furthermore, several parameters including the type of procedure, the profile of patients and their socio-economic status must be taken into account to implement centralization.