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Erschienen in:

01.01.2008 | Hepatobiliary and Pancreatic Tumors

Variations in Surgical Treatment and Outcomes of Patients With Pancreatic Cancer: A Population-Based Study

verfasst von: Anand Govindarajan, MD, MSc, Jensen C. C. Tan, MD, Nancy N. Baxter, MD, PhD, Natalie G. Coburn, MD, MPH, Calvin H. L. Law, MD, MPH

Erschienen in: Annals of Surgical Oncology | Ausgabe 1/2008

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Abstract

Background

There is ongoing debate on how variations in surgical technique affect outcomes in pancreatic cancer. This population-based study examines current surgical practice and outcomes for cancer of the pancreatic head.

Methods

All patients 18 to 85 years old diagnosed with nonmetastatic adenocarcinoma of the pancreatic head from 1998 through 2003 were identified from the Surveillance, Epidemiology and End Results (SEER) Program registry. Multivariable regression was used to elucidate factors associated with the type of pancreaticoduodenectomy performed, extent of lymph node (LN) assessment, early mortality, and late survival.

Results

Overall, 2111 patients were included in the study, with 83.7% treated with a standard Whipple pancreaticoduodenectomy (PD). However, there was marked regional variation in the use of pylorus-preserving pancreaticoduodenectomy (PPPD; range, .03%–32.0%; P < .0001) and total pancreatectomy (TP; range, .04%–19.5%; P < .0001). TP was associated with significantly higher early mortality (odds ratio, 2.6; 95% confidence interval, 1.6 to 4.1; P < .0001), but late survival did not differ significantly between TP, PPPD, and PD (P = .69). Significant variation was also seen in the number of LN assessed (range across SEER regions, 7.3–13.5; P < .0001). Decreased LN assessment reduced the odds of diagnosing a patient as node positive and was associated with worse late survival.

Conclusions

In this population-based study, we found marked clinically important variability in the surgical treatment of adenocarcinoma of the pancreatic head, with respect to the use of TP, PPPD, or PD, and the extent of LN assessment. Further research is warranted to elucidate the underlying reasons, and to clarify the role of adequate lymphadenectomy.

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Titel: Variations in Surgical Treatment and Outcomes of Patients With Pancreatic Cancer: A Population-Based Study
verfasst von: Anand Govindarajan, MD, MSc
Jensen C. C. Tan, MD
Nancy N. Baxter, MD, PhD
Natalie G. Coburn, MD, MPH
Calvin H. L. Law, MD, MPH
Publikationsdatum: 01.01.2008
Verlag: Springer-Verlag
Erschienen in: Annals of Surgical Oncology / Ausgabe 1/2008
Print ISSN: 1068-9265
Elektronische ISSN: 1534-4681
DOI: https://doi.org/10.1245/s10434-007-9601-7

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Abstract

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Conclusions

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