TY - JOUR
T1 - Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies
AU - van Roessel, Stijn
AU - Mackay, Tara M
AU - Tol, Johanna A M G
AU - van Delden, Otto M
AU - van Lienden, Krijn P
AU - Nio, Chung Y
AU - Phoa, Saffire S K S
AU - Fockens, Paul
AU - van Hooft, Jeanin E
AU - Verheij, Joanne
AU - Wilmink, Johanna W
AU - van Gulik, Thomas M
AU - Gouma, Dirk J
AU - Busch, Olivier R
AU - Besselink, Marc G
N1 - Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.
PY - 2019/7/1
Y1 - 2019/7/1
N2 - BACKGROUND: Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.METHODS: All consecutive PDs performed between 1992-2017 in a single pancreatic center were identified from a prospectively maintained database and analyzed according to three time periods.RESULTS: In total, 1434 patients underwent PD. Over time, more elderly patients underwent PD (P < 0.001) with increased use of vascular resection (10.4 to 16.0%, P < 0.001). In patients with cancer (n = 1049, 74.8%), the proportion pT3/T4 tumors increased from 54.3% to 70.6% over time (P < 0.001). The postoperative pancreatic fistula (16.0%), postpancreatectomy hemorrhage (8.0%) and delayed gastric emptying (31.0%) rate did not reduce over time, whereas median length of stay decreased from 16 to 12 days (P < 0.001). The overall failure-to-rescue rate (6.9%) and in-hospital mortality (2.2%) remained stable (P = 0.89 and P = 0.45). In 523 patients with pancreatic cancer (36.5%), the use of both adjuvant and neoadjuvant chemotherapy increased over time (both p<0.001), and the five-year overall survival improved from 11.0% to 17.4% (P < 0.001).CONCLUSIONS: In a period where indications for PD expanded, with more elderly patients, more advanced cancers and increased use of vascular resections, surgical outcome remained favorable and five-year survival for pancreatic cancer improved.
AB - BACKGROUND: Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.METHODS: All consecutive PDs performed between 1992-2017 in a single pancreatic center were identified from a prospectively maintained database and analyzed according to three time periods.RESULTS: In total, 1434 patients underwent PD. Over time, more elderly patients underwent PD (P < 0.001) with increased use of vascular resection (10.4 to 16.0%, P < 0.001). In patients with cancer (n = 1049, 74.8%), the proportion pT3/T4 tumors increased from 54.3% to 70.6% over time (P < 0.001). The postoperative pancreatic fistula (16.0%), postpancreatectomy hemorrhage (8.0%) and delayed gastric emptying (31.0%) rate did not reduce over time, whereas median length of stay decreased from 16 to 12 days (P < 0.001). The overall failure-to-rescue rate (6.9%) and in-hospital mortality (2.2%) remained stable (P = 0.89 and P = 0.45). In 523 patients with pancreatic cancer (36.5%), the use of both adjuvant and neoadjuvant chemotherapy increased over time (both p<0.001), and the five-year overall survival improved from 11.0% to 17.4% (P < 0.001).CONCLUSIONS: In a period where indications for PD expanded, with more elderly patients, more advanced cancers and increased use of vascular resections, surgical outcome remained favorable and five-year survival for pancreatic cancer improved.
UR - https://www.scopus.com/inward/record.uri?partnerID=HzOxMe3b&scp=85059223530&origin=inward
UR - https://www.ncbi.nlm.nih.gov/pubmed/30606684
U2 - https://doi.org/10.1016/j.hpb.2018.10.020
DO - https://doi.org/10.1016/j.hpb.2018.10.020
M3 - Article
C2 - 30606684
SN - 1365-182X
VL - 21
SP - 865
EP - 875
JO - HPB: The official journal of the International Hepato Pancreato Biliary Association
JF - HPB: The official journal of the International Hepato Pancreato Biliary Association
IS - 7
ER -