先前对胰腺癌护理分散化的研究并未根据癌症认证委员会等医院质量指标进行调整。分散化护理的影响尚未明确。我们查询了国家癌症数据库，以确定 2006 年至 2019 年间接受胰十二指肠切除术和远端胰腺切除术并接受围术期全身治疗的临床 I-III 期胰腺癌患者。与进行手术的中心不同的中心被归类为护理分散。根据是否（癌症委员会的护理碎片化）或非癌症委员会的护理碎片化）系统治疗是否在癌症委员会认可的机构进行，对具有碎片化护理的患者进行了进一步分类。 11,732 名患者符合纳入标准； 5,668 例 (48.3%) 接受了碎片化护理，3,426 例 (29.2%) 接受了非癌症委员会的碎片化护理。接受非癌症委员会分散式护理的患者接受新辅助全身治疗的可能性低于接受癌症委员会分散式护理或非分散式护理的患者（27.7% vs 40.1% vs 36.8%，P < .001）。根据 Cox 分析，高龄、合并症、淋巴结阳性疾病和设施类型与总生存风险相关。护理分散化则不然（调整后的风险比 = 0.99，95% 置信区间 [0.94-1.06]，P = .8）。根据 Kaplan-Meier 分析，治疗队列之间的 5 年总生存率没有显着差异。在接受局部胰腺癌分散护理的患者中，那些在癌症委员会认可的设施中接受全身治疗的患者更有可能接受新辅助治疗治疗，但与接受非分散护理的患者或接受分散护理但在未经认可的机构接受系统治疗的患者相比，生存率没有显着改善。版权所有 © 2023 Elsevier Inc. 保留所有权利。

Prior studies of fragmentation of care in pancreatic cancer have not adjusted for indicators of hospital quality such as Commission on Cancer accreditation. The effect of fragmentation of care has not been well defined.We queried the National Cancer Database to identify patients undergoing pancreaticoduodenectomy and distal pancreatectomy with perioperative systemic therapy for clinical stages I-III pancreatic cancer between 2006 and 2019. Patients who received systemic therapy at a center different than the center performing surgery were categorized as having fragmentation of care. Patients having fragmentation of care were further categorized on the basis of whether (fragmentation of care Commission on Cancer) or not (fragmentation of care non-Commission on Cancer) systemic therapy was administered at a facility accredited by the Commission on Cancer.A total of 11,732 patients met inclusion criteria; 5,668 (48.3%) underwent fragmentation of care, and 3,426 (29.2%) fragmentation of care non-Commission on Cancer. Patients undergoing fragmentation of care non-Commission on Cancer were less likely to receive neoadjuvant systemic therapy than those undergoing fragmentation of care Commission on Cancer or non-fragmented care (27.7% vs 40.1% vs 36.8%, P < .001). On Cox analysis, advanced age, comorbid disease, node-positive disease, and facility type were associated with risk of overall survival. Fragmentation of care was not (adjusted hazard ratio = 0.99, 95% confidence interval [0.94-1.06], P = .8). On Kaplan-Meier analysis, there were no significant differences in 5-year overall survival between treatment cohorts.In patients undergoing fragmentation of care for localized pancreatic cancer, those treated with systemic therapy in Commission on Cancer accredited facilities are more likely to be given neoadjuvant therapy but demonstrate no significant improvement in survival relative to those undergoing non-fragmented care or those undergoing fragmentation of care but receiving systemic therapy in nonaccredited facilities.Copyright © 2023 Elsevier Inc. All rights reserved.