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Pancreatic Neoplasms: HELP
Articles by David Urbach
Based on 2 articles published since 2009
(Why 2 articles?)

Between 2009 and 2019, David Urbach wrote the following 2 articles about Pancreatic Neoplasms.
+ Citations + Abstracts
1 Article Management of pancreatic adenocarcinoma in Ontario, Canada: a population-based study using novel case ascertainment. 2011

Borgida, Ayelet Eppel / Ashamalla, Shady / Al-Sukhni, Wigdan / Rothenmund, Heidi / Urbach, David / Moore, Malcolm / Cotterchio, Michelle / Gallinger, Steven. ·Mount Sinai Hospital, Joseph and Wolf Lebovic Health Complex, 69 Murray Street, Toronto, Ontario. aborgida@mtsinai.on.ca ·Can J Surg · Pubmed #21251433.

ABSTRACT: BACKGROUND: Pancreatic adenocarcinoma (PA) is largely incurable, although recent progress has been made in the safety of surgery for PA and in adjuvant and palliative chemotherapy. The purpose of this study was to describe the management of PA in Ontario, Canada. METHODS: The Pathology Information Management System (PIMS), which uses electronic pathology reporting (E-path), was used to rapidly identify and recruit patients based on a pathologic diagnosis of PA between 2003 and 2006. Patients were mailed questionnaires for additional data. RESULTS: The patient participation rate was 26% (351 of 1325). Nonresponders were more likely to be older than 70 years (43% v. 28%, p < 0.001) and to have received treatment in nonacademic centres (53% v. 34%, p < 0.001). Fifty-four percent of responders underwent a potentially curative operation, and most (77%) were 70 years or younger (p = 0.03). Completed resections were documented in 83% of patients who underwent exploratory surgery with curative intent; 17% of patients had unresectable and/or metastatic disease at laparotomy. Of the completed resections, 24% were performed in nonacademic centres with a 32% positive margin rate; 76% were performed in academic centres with a 29% positive margin rate (p = 0.84). Resections with curative intent were less frequently aborted in academic centres (10% v. 33%, p < 0.001). Of the patients who responded to our questionnaire, 43% received chemotherapy and 7% participated in clinical trials. CONCLUSION: Despite using PIMS and E-path, the response rate for this study was low (< 30%). Nonresponders were older and more commonly treated in nonacademic centres. Patients undergoing surgery in academic centres had higher resection rates. The rate of adjuvant and palliative chemotherapy was stage-dependent and low.

2 Article Assessing the volume-outcome hypothesis and region-level quality improvement interventions: pancreas cancer surgery in two Canadian Provinces. 2010

Simunovic, Marko / Urbach, David / Major, Diane / Sutradhar, Rinku / Baxter, Nancy / To, Teresa / Brown, Adalsteinn / Davis, Dave / Levine, Mark N. ·Department of Surgery, Hamilton Health Sciences, McMaster University, Hamilton, ON, Canada. marko.simunovic@jcc.hhsc.ca ·Ann Surg Oncol · Pubmed #20625843.

ABSTRACT: BACKGROUND: The volume-outcome hypothesis suggests that if increased provider procedure volume is associated with improved patient outcomes, then greater regionalization to high-volume providers should improve region-level outcomes. Quality improvement interventions for pancreas cancer surgery implemented in year 1999 in Ontario, Canada were designed to regionalize surgery to high-volume hospitals and decrease operative mortality. Similar interventions were not used in Quebec, Canada. We assessed the volume-outcome hypothesis and the impact of the Ontario quality improvement interventions. MATERIALS AND METHODS: Administrative databases helped identify pancreatic resections from years 1994 to 2004 and relevant patient and hospital characteristics. Hospitals were high-volume if they provided ≥10 procedures in a given calendar year. Outcomes were regionalization of surgery to high-volume providers and rates of operative mortality. RESULTS: From 1994 to 2004 the percentage of cases in high-volume hospitals increased from 33 to 71% in Ontario and from 36 to 76% in Quebec. Annual rates of operative mortality dropped in Ontario (10.4-2.2% or less) and changed little in Quebec (7.2-9.8%). Changes in measures over time in both provinces were similar before and after year 1999. CONCLUSIONS: Regionalization was associated with improved operative mortality in Ontario but not in Quebec, undermining the volume-outcome hypothesis. The Ontario quality improvement interventions likely were of little influence since patterns in regionalization and operative mortality were similar before and after year 1999.