Determinants of outcomes following resection for pancreatic cancer—a population-based study

Waterhouse, Mary A., Burmeister, Elizabeth A., O'Connell, Dianne L., Ballard, Emma L., Jordan, Susan J., Merrett, Neil D., Goldstein, David, Wyld, David, Janda, Monika, Beesley, Vanessa L., Payne, Madeleine E., Gooden, Helen M. and Neale, Rachel E. (2016) Determinants of outcomes following resection for pancreatic cancer—a population-based study. Journal of Gastrointestinal Surgery, 20 8: 1471-1481. doi:10.1007/s11605-016-3157-4


Author Waterhouse, Mary A.
Burmeister, Elizabeth A.
O'Connell, Dianne L.
Ballard, Emma L.
Jordan, Susan J.
Merrett, Neil D.
Goldstein, David
Wyld, David
Janda, Monika
Beesley, Vanessa L.
Payne, Madeleine E.
Gooden, Helen M.
Neale, Rachel E.
Title Determinants of outcomes following resection for pancreatic cancer—a population-based study
Journal name Journal of Gastrointestinal Surgery   Check publisher's open access policy
ISSN 1091-255X
1873-4626
Publication date 2016-08
Year available 2016
Sub-type Article (original research)
DOI 10.1007/s11605-016-3157-4
Open Access Status Not Open Access
Volume 20
Issue 8
Start page 1471
End page 1481
Total pages 11
Place of publication New York, NY United States
Publisher Springer New York
Collection year 2017
Language eng
Formatted abstract
Background

Patient and health system determinants of outcomes following pancreatic cancer resection, particularly the relative importance of hospital and surgeon volume, are unclear. Our objective was to identify patient, tumour and health service factors related to mortality and survival amongst a cohort of patients who underwent completed resection for pancreatic cancer.

Methods

Eligible patients were diagnosed with pancreatic adenocarcinoma between July 2009 and June 2011 and had a completed resection performed in Queensland or New South Wales, Australia, with either tumour-free (R0) or microscopically involved margins (R1) (n = 270). Associations were examined using logistic regression (for binary outcomes) and Cox proportional hazards or stratified Cox models (for time-to-event outcomes).

Results

Patients treated by surgeons who performed <4 resections/year were more likely to die from a surgical complication (versus ≥4 resections/year, P = 0.04), had higher 1-year mortality (P = 0.03), and worse overall survival up to 1.5 years after surgery (adjusted hazard ratio 1.58, 95 % confidence interval 1.07–2.34). Amongst patients who had ≥1 complication within 30 days of surgery, those aged ≥70 years had higher 1-year mortality compared to patients aged <60 years. Adjuvant chemotherapy treatment improved recurrence-free survival (P = 0.01). There were no significant associations between hospital volume and mortality or survival.

Conclusions

Systems should be implemented to ensure that surgeons are completing a sufficient number of resections to optimize patient outcomes. These findings may be particularly relevant for countries with a relatively small and geographically dispersed population.
Keyword Pancreatic cancer
Resection
Mortality
Q-Index Code C1
Q-Index Status Provisional Code
Institutional Status UQ

Document type: Journal Article
Sub-type: Article (original research)
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