Redefining Mortality After Pancreatic Cancer Resection

Carroll, James E.; Smith, Jillian K.; Simons, Jessica P.; Murphy, Melissa M.; Ng, Sing Chau; Shah, Shimul A.; Zhou, Zheng; Tseng, Jennifer F.

doi:10.1007/s11605-010-1326-4

Cited by 28 publications

(22 citation statements)

References 16 publications

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“…Therefore, possibly more elderly patients in the Netherlands could benefit from pancreatic surgery [2,10]. Several studies on surgical risks of patients with gastrointestinal cancers showed that postoperative mortality prolonged beyond the 30-day postoperative period [3,[19][20][21]. In a recent study, a doubling of the 30-day mortality rate after pancreatic surgery was found by 90 days postoperative [3].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

et al. 2015

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Background: At a national level, it is unknown to what degree elderly patients with pancreatic or periampullary carcinoma benefit from surgical treatment compared to their younger counterparts. We investigated resection rates and outcomes after surgical treatment among elderly patients. Methods: From the Netherlands Cancer Registry, 20 005 patients diagnosed with primary pancreatic or periampullary cancer in 2005-2013 were selected. The associations between age (570, 70-74, 75-79, 80 years) and resection rates were investigated using 2 tests, and surgical outcomes (30-, 90-day mortality) were evaluated using logistic regression analysis. Overall survival after resection was investigated by means of Kaplan-Meier and Cox proportional hazard regression analysis. Results: During the study period, resection rates increased in all age groups (570 years: 20-30%, p50.001; 80 years: 2-8%, p50.001). Of 3845 patients who underwent tumour resection for pancreatic or periampullary carcinoma, the proportion of octogenarians increased from 3.5% to 5.5% (p ¼ 0.03), whereas postoperative mortality did not increase (30-day: 6-3%, p ¼ 0.06; 90-day: 9-8%, p ¼ 0.21). With rising age, 30-day postoperative mortality increased (4-5-7-8%, respectively, p50.001), while 90-day mortality was 6-10-13-12% (p50.001) and three-year overall survival rates after surgery were 35-33-28-31%, respectively (p50.001). After adjustment for confounding factors, octogenarians who survived 90 days postoperative exhibited an overall survival close to younger patients [hazard ratio (80 vs.570 years) ¼ 1.21, 95% confidence interval (0.99-1.47), p ¼ 0.07]. Conclusion: Despite higher short-term mortality, octogenarians who underwent pancreatic resection showed long-term survival similar to younger patients. With careful patient screening and counselling of elderly patients, a further increase of resection rates may be combined with improved outcomes.

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Section: Discussionmentioning

confidence: 99%

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

et al. 2015

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“…2 Of those who do, some may quickly succumb to recurrent disease or develop postoperative complications. [3][4][5][6] Abdominal imaging is widely used in the resected pancreatic cancer population. In addition to evaluating patients with new symptoms or complications, many physicians also perform serial imaging at routine intervals to evaluate for recurrent disease.…”

Section: Introductionmentioning

confidence: 99%

Is It Worth Looking? Abdominal Imaging After Pancreatic Cancer Resection: a National Study

Witkowski

Smith

Ragulin-Coyne

et al. 2012

Journal of Gastrointestinal Surgery

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“…Postoperative mortality is strictly dependent on the type of procedure and the hospital resection volume [6,7,11,12,13,14]. The majority of NF-PETs are resectable with a distal or a limited pancreatectomy and often with enucleation [3,4,5].…”

Section: Methodsmentioning

confidence: 99%

“…The majority of NF-PETs are resectable with a distal or a limited pancreatectomy and often with enucleation [3,4,5]. Mortality resulting from a distal pancreatectomy is reported to be at most 1-2% [12,13,14]. In the present study, baseline 30-day mortality was assumed to be 1.5% [12] and ranged from 0 to 3% [13,14].…”

Section: Methodsmentioning

confidence: 99%

“…Mortality resulting from a distal pancreatectomy is reported to be at most 1-2% [12,13,14]. In the present study, baseline 30-day mortality was assumed to be 1.5% [12] and ranged from 0 to 3% [13,14]. Morbidity was considered to be the occurrence of major postoperative complications or serious adverse events as the result of this type of procedure, on the basis of the ICD9 codes, as reported by the United States Healthcare Cost and Utilization Project [13].…”

Section: Methodsmentioning

confidence: 99%

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Efficacy and Cost-Effectiveness of Immediate Surgery versus a Wait-and-See Strategy for Sporadic Nonfunctioning T1 Pancreatic Endocrine Neoplasms

et al. 2014

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Background: Whether patients with small (<2 cm), sporadic nonfunctioning pancreatic endocrine tumors (NF-PETs) should directly undergo pancreatic surgery or should be followed longitudinally to detect growth and malignancy still has to be defined. Study Design: Based on the pertinent literature of the past decade, a Markov model was developed to investigate this issue. In the wait-and-see strategy arm, surgery was performed if the tumor attained a size ≥2 cm or surpassed 20% of the initial size. In a Monte Carlo probabilistic analysis, 100 hypothetical patients undergoing a wait-and-see strategy were compared to 100 patients directly undergoing surgery, with the aim of investigating the efficacy and cost-effectiveness of the two strategies. Results: During the postdiagnostic lifetime, 63 NF-PETs in the wait-and-see group showed significant growth and underwent surgery: 38 were stage I, 10 were stage II, 15 were stage III and none were stage IV. In the base-case scenario, the mean life expectancy and quality-adjusted life expectancy were found to be superior after immediate surgery [26.1 years and 11.8 quality-adjusted life years (QALYs)] than with the wait-and-see strategy (22.1 years and 8.3 QALYs) as the consequence of ageing during the wait-and-see follow-up which increased mortality due to surgery, when surgery was needed. The model was sensitive to starting age and length of follow-up; in particular, for patients >65 years of age, the two strategies provided similar results but the wait-and-see strategy was more cost-effective. Conclusions: The wait-and-see strategy for NF-PETs <2 cm represents a reasonable approach in patients over 65 years of age; otherwise, immediate surgery is preferable.

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Redefining Mortality After Pancreatic Cancer Resection

Cited by 28 publications

References 16 publications

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

Pancreatic cancer surgery in elderly patients: Balancing between short-term harm and long-term benefit. A population-based study in the Netherlands

Is It Worth Looking? Abdominal Imaging After Pancreatic Cancer Resection: a National Study

Efficacy and Cost-Effectiveness of Immediate Surgery versus a Wait-and-See Strategy for Sporadic Nonfunctioning T1 Pancreatic Endocrine Neoplasms

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