TY - JOUR
T1 - Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer
AU - van der Geest, L. G. M.
AU - Lemmens, V. E. P. P.
AU - de Hingh, I. H. J. T.
AU - van Laarhoven, C. J. H. M.
AU - Bollen, T. L.
AU - Nio, C. Y.
AU - van Eijck, C. H. J.
AU - Busch, O. R. C.
AU - Besselink, M. G.
PY - 2017
Y1 - 2017
N2 - BackgroundDespite improvements in diagnostic imaging and staging, unresectable pancreatic cancer is still encountered during surgical exploration with curative intent. This nationwide study investigated outcomes in patients with unresectable pancreatic cancer found during surgical exploration. MethodsAll patients diagnosed with primary pancreatic (adeno)carcinoma (2009-2013) in the Netherlands Cancer Registry were included. Predictors of unresectability, 30-day mortality and poor survival were evaluated using logistic and Cox proportional hazards regression analysis. ResultsThere were 10 595 patients with pancreatic cancer during the study interval. The proportion of patients undergoing surgical exploration increased from 199 to 270 per cent (P <0001). Among 2356 patients who underwent surgical exploration, the proportion of patients with tumour resection increased from 616 per cent in 2009 to 713 per cent in 2013 (P <0001), whereas the contribution of M1 disease (185 per cent overall) remained stable. Patients who had exploration only had an increased 30-day mortality rate compared with those who underwent tumour resection (78 versus 38 per cent; P <0001). In the non-resected group, among those with M0 (383 patients) and M1 (435) disease at surgical exploration, the 30-day mortality rate was 47 and 106 per cent (P = 0002), median survival was 72 and 44months (P <0001), and 1-year survival rates were 280 and 129 per cent, respectively. Among other factors, low hospital volume (0-20 resections per year) was an independent predictor for not undergoing tumour resection, but also for 30-day mortality and poor survival among patients without tumour resection. ConclusionExploration and resection rates increased, but one-third of patients who had surgical exploration for pancreatic cancer did not undergo resection. Non-resectional surgery doubled the 30-day mortality rate compared with that in patients undergoing tumour resection. Negative impacts
AB - BackgroundDespite improvements in diagnostic imaging and staging, unresectable pancreatic cancer is still encountered during surgical exploration with curative intent. This nationwide study investigated outcomes in patients with unresectable pancreatic cancer found during surgical exploration. MethodsAll patients diagnosed with primary pancreatic (adeno)carcinoma (2009-2013) in the Netherlands Cancer Registry were included. Predictors of unresectability, 30-day mortality and poor survival were evaluated using logistic and Cox proportional hazards regression analysis. ResultsThere were 10 595 patients with pancreatic cancer during the study interval. The proportion of patients undergoing surgical exploration increased from 199 to 270 per cent (P <0001). Among 2356 patients who underwent surgical exploration, the proportion of patients with tumour resection increased from 616 per cent in 2009 to 713 per cent in 2013 (P <0001), whereas the contribution of M1 disease (185 per cent overall) remained stable. Patients who had exploration only had an increased 30-day mortality rate compared with those who underwent tumour resection (78 versus 38 per cent; P <0001). In the non-resected group, among those with M0 (383 patients) and M1 (435) disease at surgical exploration, the 30-day mortality rate was 47 and 106 per cent (P = 0002), median survival was 72 and 44months (P <0001), and 1-year survival rates were 280 and 129 per cent, respectively. Among other factors, low hospital volume (0-20 resections per year) was an independent predictor for not undergoing tumour resection, but also for 30-day mortality and poor survival among patients without tumour resection. ConclusionExploration and resection rates increased, but one-third of patients who had surgical exploration for pancreatic cancer did not undergo resection. Non-resectional surgery doubled the 30-day mortality rate compared with that in patients undergoing tumour resection. Negative impacts
U2 - https://doi.org/10.1002/bjs.10602
DO - https://doi.org/10.1002/bjs.10602
M3 - Article
C2 - 28832964
SN - 0007-1323
VL - 104
SP - 1568
EP - 1577
JO - British Journal of Surgery
JF - British Journal of Surgery
IS - 11
ER -