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Pancreatic & liver cancer specialist centres NSW

Criteria for a specialist pancreatic cancer, liver cancer, and cholangiocarcinoma surgery

A pancreatectomy is surgery to remove of all or part of the pancreas. It is complex surgery, which requires a team of health care professionals with suitable experience performing this surgery and providing supportive care after surgery.[1,2]

Surgery for cancers of the liver or biliary system (hepatocellular carcinoma and cholangiocarcinoma) is also complex and requires similar care to pancreatectomy.

Australian and international studies indicate that patient outcomes can be improved when these types of complex surgeries are performed in centres that do a high number of these procedures.[3–8]

It is recommended that specialist pancreatic and liver cancer centres perform 6 pancreatectomies per year*

* The minimum suggested annual surgical caseload for a cancer specialist centre is six pancreatectomies per year. This threshold has been selected based on international studies, the hospital-level distribution of pancreatectomies in NSW, and consultation with clinicians.[3–8]

It is based on the number of pancreatectomies only. Due to similarities in anatomy, surgical complexity, and supportive care required centres will be recommended for all of these cancer types if they meet the minimum suggested annual surgical caseload for pancreatectomy.

Multidisciplinary cancer care team availability

Patients with cancers of the pancreas, liver or biliary system may have one or more types of treatment, including surgery, endoscopic treatments, chemotherapy, radiotherapy, and tumour ablation or embolization.

The involvement of a multidisciplinary cancer care team is required.[1,2] This team brings together health care professionals from different specialties to discuss a patient’s cancer diagnosis and staging, and their treatment options. It also enhances communication and care co-ordination between the specialists involved in a patient’s care.

Australian and international studies show that patients overseen by a multidisciplinary cancer care team experience better outcomes after cancer treatment.[9-11]

Actions for Health Professionals

Actions for Health Professionals

Patient referral

Patients with a suspected or confirmed cancer of the pancreas, liver or biliary tract should be referred to a specialist who is a member of a multidisciplinary cancer care team and practices at one of the specialist centres listed below.

Even if surgery does not seem likely at the time of referral, involvement of a multidisciplinary team (MDT) early in the cancer journey is recommended to ensure optimal assessment, care, and outcomes.

The Canrefer website allows you to find cancer specialists who are MDT members, and has information about cancer services, optimal care pathways, and patient resources.

Smoking cessation support

Evidence suggests that tobacco cessation following cancer diagnosis improves survival. It also reduces treatment-related complications.[13–14] Health professionals should discuss tobacco use with all patients and provide appropriate cessation support.

List of specialist centres for pancreatic cancer, primary liver cancer, and cholangiocarcinoma surgery  

Local health district

Hospital

Annual average pancreatectomy caseload
Jan 2017 – Dec 2018

South Eastern Sydney

Prince of Wales Hospital

26-35

Sydney

Royal Prince Alfred Hospital

26-35

Northern Sydney

Royal North Shore Hospital

26-35

Hunter New England

John Hunter Hospital

16-20

Western Sydney

Westmead Hospital

16-20

South Western Sydney

Bankstown / Lidcombe Hospital

16-20

Illawarra Shoalhaven

Wollongong Hospital

16-20

South Eastern Sydney

St George Hospital

6-10

Nepean Blue Mountains

Nepean Hospital

6-10

  • Surgical caseload data sourced from Admitted Patient, Emergency Department Attendance, and Deaths Register (APEDDR) via Secure Analytics for Population Health Research and Intelligence (SAPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health.
  • In-scope diagnoses (pancreatic cancer): C17.0, C24, C25
  • In-scope procedures (pancreatectomy): 30583-00, 30584-00, 30593-00, 30593-01
  • The data presented are for pancreatectomy only. Co-listing for liver resection is based on meeting the minimum suggested annual caseload for pancreatectomy.
  • The annual average surgical caseload is based on a two-year average, to account for annual variations in surgical volumes.

List of private specialist centres for pancreatic cancer, primary liver cancer, and cholangiocarcinoma surgery
 

Local health district Hospital* Annual average pancreatectomy caseload
Jul 2016 – Jun 2018

Northern Sydney

North Shore Private Hospital

31-35

South Eastern Sydney

St George Private Hospital

16-20

South Eastern Sydney

Prince of Wales Private Hospital

16-20

Sydney

Chris O'Brien Lifehouse

11-15

Northern Sydney

Sydney Adventist Hospital

11-15

Northern Sydney

Mater Hospital North Sydney

6-10

Western Sydney

Norwest Private Hospital

6-10

St Vincent's Network

St Vincent's Private Hospital, Darlinghurst

6-10

  • Surgical caseload data sourced from Admitted Patient, Emergency Department Attendance, and Deaths Register (APEDDR) via Secure Analytics for Population Health Research and Intelligence (SAPHaRI), Centre for Epidemiology and Evidence, NSW Ministry of Health.
  • In-scope diagnoses (pancreatic cancer): C17.0, C24, C25
  • In-scope procedures (pancreatectomy): 30583-00, 30584-00, 30593-00, 30593-01
  • The data presented are for pancreatectomy only. Co-listing for liver resection is based on meeting the minimum suggested annual caseload for pancreatectomy.
  • The annual average surgical caseload is based on a two-year average, to account for annual variations in surgical volumes.

*Private specialists centres listed have given permission to be included on the Cancer Institute NSW website.

References

  1. Department of Health and Human Services. Optimal care pathway for people with pancreatic cancer. State Government of Victoria, Melbourne. 2015.
  2. Department of Health and Human Services. Optimal care pathway for people with hepatocellular carcinoma. State Government of Victoria, Melbourne. 2014.
  3. Birkmeyer JD, et al. Hospital volume and surgical mortality in the United States. N Engl J Med, 2002. 346(15):1128–to37.
  4. Killeen SD, et al. Provider volume and outcomes for oncological procedures. Br J Surg, 2005. 92(4):389–to402.
  5. Birkmeyer JD, et al. Hospital volume and late survival after cancer surgery. Ann Surg, 2007. 245(5):777–to83.
  6. Finks JF, et al. Trends in hospital volume and operative mortality for high-risk surgery. N Engl J Med, 2011. 364(22):2128–to37.
  7. Gooiker GA, et al. Systematic review and meta-analysis of the volume-outcome relationship in pancreatic surgery. Br J Surg, 2011. 98(4):485–to94.
  8. Azzam DG, et al. The Western Australian Audit of Surgical Mortality: outcomes from the first 10 years. Med J Aust, 2013. 199(8):539–to42.
  9. Samra JS, et al. One hundred and seventy eight consecutive pancreatoduodenectomies without mortality: role of the multidisciplinary approach. Hepatobiliary Pancreat Dis Int, 2011. 10(4):415–to21.
  10. Kersten C, et al. Does in-house availability of multidisciplinary teams increase survival in upper gastrointestinal cancer? World J Gastrointest Oncol, 2013. 5(3):60–to7.
  11. Naugler WE, et al. Building the multidisciplinary team for management of patients with hepatocellular carcinoma. Clin Gastroenterol Hepatol, 2015. 13(5):827–to35.
  12. Karam-Hage M, et al. Tobacco use and cessation for cancer survivors: an overview for clinicians. CA Cancer J Clin. 2014. 64(4):272–to90.
  13. Warren GW, et al. The biological and clinical effects of smoking by patients with cancer and strategies to implement evidence-based tobacco cessation support. Lancet Oncol. 2014. 15(12):e568–to80.
  14. Florou AN, et al. Clinical significance of smoking cessation in subjects with cancer: a 30-year review. Respir Care. 2014. 59(12):1924–to36.