The 90-Day Mortality After Pancreatectomy for Cancer Is Double the 30-Day Mortality: More than 20,000 Resections From the National Cancer Data Base

Swanson, Richard S.; Pezzi, Christopher M.; Mallin, Katherine; Loomis, Ashley; Winchester, David P.

doi:10.1245/s10434-014-4036-4

Cited by 155 publications

(114 citation statements)

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“…Despite increasing resection rates in the course of our study, 30-day postoperative mortality slightly decreased in elderly patients who underwent resection for pancreatic or periampulary carcinoma. Thirty-day postoperative mortality in octogenarians (7.7%) in our study was in line with previous population-based and multi-institutional studies showing a (30-day and/or in-hospital) postoperative mortality between 4.7% and 15.5% [3,4,10]. In concordance with a large observational study of patients undergoing pancreatoduodenectomy for cancer [12], short-term mortality risk of octogenarians in our study did not differ from that of other elderly age groups.…”

Section: Discussionsupporting

confidence: 92%

“…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%

“…Tumour stage (TNM) was categorised as 'loco-regional' (T1-2-3 or N+, M0), 'extended' (T4M0), 'metastatic' (M1) or 'unknown' (X), based on pathological TNM and irrespective of tumour location. To account for late fatal outcomes of postoperative complications [3], both 30-and 90-day mortality of any cause after date of tumour resection were evaluated. Survival time was defined as the time from the date of tumour resection to the date of death.…”

Section: Patientsmentioning

confidence: 99%

“…Therefore, in the past this type of surgery was restricted to relatively young patients. Together with centralisation of pancreatic surgery, postoperative mortality after pancreatic surgery has decreased; with in-hospital and 30-day mortality rates reported under 5% [2,3]. With improving postoperative mortality risk, more elderly patients, including fit octogenarians, may be offered pancreatic surgery [4].…”

mentioning

confidence: 99%

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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: Discussionsupporting

confidence: 92%

Section: Discussionmentioning

confidence: 99%

Section: Patientsmentioning

confidence: 99%

mentioning

confidence: 99%

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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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“…In is worth to mention however that even nowadays the mortality after pancreatectomies is not nil, particularly after pancreatico-duodenectomies. Thus, Swanson and co-workers have shown that the 90-day mortality after pancreatic resections for cancer is double the 30-day mortality (7.4% vs. 3.7%) (20).…”

Section: Resectable Pdacmentioning

confidence: 99%

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Popescu¹,

Dumitraşcu²

2017

SGO

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Pancreatic ductal adenocarcinoma (PDAC) is an important healthcare problem because is a leading cause of death by cancer. PDAC is a highly lethal disease with a very dismal prognosis. Most patients present advanced disease at diagnosis. The management of a patient diagnosed with PDAC should be discussed in a multidisciplinary team in high-volume centers. Pancreatectomy represents the single hope of long-term survival for a patient with PDAC but the resectability rate is less than 20% of the cases. Several progresses were observed in the last years regarding the surgical and oncological approach for PDAC. The aim of the paper is to make a brief review of the current onco-surgical strategies available for patients with PDAC.

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Screening for Pancreatic Cancer

Owens

Davidson

Krist

et al. 2019

JAMA

278

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US Preventive Services Task Force T he US Preventive Services Task Force (USPSTF) makes recommendations about the effectiveness of specific preventive care services for patients without obvious related signs or symptoms.It bases its recommendations on the evidence of both the benefits and harms of the service and an assessment of the balance. The USPSTF does not consider the costs of providing a service in this assessment.The USPSTF recognizes that clinical decisions involve more considerations than evidence alone. Clinicians should understand the evidence but individualize decision making to the specific patient or situation. Similarly, the USPSTF notes that policy and coverage decisions involve considerations in addition to the evidence of clinical benefits and harms. Summary of Recommendation and EvidenceThe USPSTF recommends against screening for pancreatic cancer in asymptomatic adults (D recommendation) (Figure 1). RationaleImportance Pancreatic ductal adenocarcinoma (referred to hereafter as pancreatic cancer) is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years IMPORTANCE Pancreatic cancer is an uncommon cancer with an age-adjusted annual incidence of 12.9 cases per 100 000 person-years. However, the death rate is 11.0 deaths per 100 000 person-years because the prognosis of pancreatic cancer is poor. Although its incidence is low, pancreatic cancer is the third most common cause of cancer death in the United States. Because of the increasing incidence of pancreatic cancer, along with improvements in early detection and treatment of other types of cancer, it is estimated that pancreatic cancer may soon become the second-leading cause of cancer death in the United States.OBJECTIVE To update the 2004 US Preventive Services Task Force (USPSTF) recommendation on screening for pancreatic cancer. EVIDENCE REVIEWThe USPSTF reviewed the evidence on the benefits and harms of screening for pancreatic cancer, the diagnostic accuracy of screening tests for pancreatic cancer, and the benefits and harms of treatment of screen-detected or asymptomatic pancreatic cancer.FINDINGS The USPSTF found no evidence that screening for pancreatic cancer or treatment of screen-detected pancreatic cancer improves disease-specific morbidity or mortality, or all-cause mortality. The USPSTF found adequate evidence that the magnitude of the benefits of screening for pancreatic cancer in asymptomatic adults can be bounded as no greater than small. The USPSTF found adequate evidence that the magnitude of the harms of screening for pancreatic cancer and treatment of screen-detected pancreatic cancer can be bounded as at least moderate. The USPSTF reaffirms its previous conclusion that the potential benefits of screening for pancreatic cancer in asymptomatic adults do not outweigh the potential harms. CONCLUSIONS AND RECOMMENDATIONThe USPSTF recommends against screening for pancreatic cancer in asymptomatic adults. (D recommendatio...

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The 90-Day Mortality After Pancreatectomy for Cancer Is Double the 30-Day Mortality: More than 20,000 Resections From the National Cancer Data Base

Cited by 155 publications

References 10 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

Onco-surgical Strategies in Pancreatic Ductal Adenocarcinoma

Screening for Pancreatic Cancer

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