The Effect of Operation Volume on the Management and Prognosis of Pancreatic Cancer Patients in Finland

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Arvo building, Jarmo Visakorpi auditorium, address: Arvo Ylpön katu 34.

Doctoral defence of Lic.Med. Reea Ahola

The Effect of Operation Volume on the Management and Prognosis of Pancreatic Cancer Patients in Finland

The field of science of the dissertation is Surgery (Gastroentorologic Surgery).

The opponent is professor Caj Haglund (University of Helsinki). Associate professor Johanna Laukkarinen acts as the custos.

The language of the dissertation defence is Finnish.

The effect of operation volume on the prognosis of pancreatic cancer patients in Finland

Pancreatic cancer   is known for poor overall prognosis the five-year survival being under 5%.  Surgery combined with oncologic therapy is currently the best way to improve five-year survival. However, only 15-20% of patients have a local, resectable disease. Moreover, pancreatic resections recognized as high risk surgery:  they are associated with increased mortality and complication risks. Internationally it has been reported that a high operation volume has a beneficial effect on the prognosis after surgery.  

This  thesis  aimed  to  study  the  effect  of operation volume on postoperative prognosis and management of pancreatic cancer  patients  in  Finland. The thesis is based on national data from years 2000-2008 and 2012-2014 retrieved from registries of National Institute for Health and Welfare, Finnish Cancer Registry and patient archives.

This thesis revealed that high operation volume is associated with decreased post-operative mortality and long-term survival. The resource utilization and costs of the surgery was analysed from the data between 2012 and 2014. The results stated that costs are lower in high volume centres than in low volume centres. The accessibility to surgery was assessed according to data from years 2003 and 2008. The study showed that proportions of patients offered surgery is greater in areas with a high volume centre than in areas with a low volume centre.

As a conclusion, this study shows that management of pancreatic cancer has differed across health care districts in Finland. The results emphasize the benefits of high operation  volume  in  planning  and  conducting  the  surgical  care  of  pancreatic cancer patients. Moreover, pancreatic resections performed in high volume centres can result in lower overall treatment costs. These findings support the centralization of pancreatic resections to high volume centres.


The dissertation is published in the publication series of Acta Universitatis Tamperensis; 2424, Tampere University Press, Tampere 2018. The dissertation is also published in the e-series Acta Electronica Universitatis Tamperensis; 1934, Tampere University Press 2018.

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