Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre.

Abstract

OBJECTIVES:

Mortality in pancreatic cancer has remained unchanged over the last 20-30 years. The aim of the present study was to analyse survival trends in a selected population of patients submitted to resection for pancreatic cancer at a single institution.

METHODS:

Included were 544 patients who underwent pancreatectomy for pancreatic cancer between 1990 and 2009. Patients were categorized into two subgroups according to the decade in which resection was performed (1990-1999 and 2000-2009). Predictors of survival were analysed using univariate and multivariate analyses.

RESULTS:

Totals of 114 (21%) and 430 (79%) resections were carried out during the periods 1990-1999 and 2000-2009, respectively (P < 0.0001). Hospital length of stay (16 days versus 10 days; P < 0.001) and postoperative mortality (3% versus 1%; P = 0.160) decreased over time. Median disease-specific survival significantly increased from 16 months in the first period to 29 months in the second period (P < 0.001). Following multivariate analysis, poorly differentiated tumour [hazard ratio (HR) 3.1, P < 0.001], lymph node metastases (HR = 1.9, P < 0.001), macroscopically positive margin (R2) resection (HR = 3.2, P < 0.0001), no adjuvant therapy (HR = 1.6, P < 0.001) and resection performed in the period 1990-1999 (HR = 2.18, P < 0.001) were significant independent predictors of a poor outcome.

CONCLUSIONS:

Longterm survival after surgery for pancreatic cancer significantly improved over the period under study. Better patient selection and the routine use of adjuvant therapy may account for this improvement.

• Authors: Giuliano Barugola, Stefano Partelli, Stefano Crippa, Giovanni Butturini, Roberto Salvia, Nora Sartori, Claudio Bassi, Massimo Falconi, Paolo Pederzoli
• Journal: HPB : the official journal of the International Hepato Pancreato Biliary Association (HPB (Oxford)) Vol. 15 Issue 12 Pg. 958-64 (Dec 2013) ISSN: 1477-2574 [Electronic] England
• PMID: 23490217 (Publication Type: Journal Article)
• Copyright: © 2013 International Hepato-Pancreato-Biliary Association.

Topics

• Carcinoma, Pancreatic Ductal (mortality, pathology, surgery)
• Chemotherapy, Adjuvant
• Chi-Square Distribution
• Female
• Humans
• Italy
• Kaplan-Meier Estimate
• Length of Stay
• Male
• Middle Aged
• Multivariate Analysis
• Neoadjuvant Therapy
• Pancreatectomy (adverse effects, mortality, trends)
• Pancreatic Neoplasms (mortality, pathology, surgery)
• Patient Selection
• Proportional Hazards Models
• Risk Factors
• Tertiary Care Centers (trends)
• Time Factors
• Treatment Outcome