Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies
Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome. All consecutive PDs performed between 1992–2017 in a single pancreatic center were identified from a prospectively maintained database...
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| Veröffentlicht in: | HPB (Oxford, England) England), 2019-07, Vol.21 (7), p.865-875 |
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| creator | van Roessel, Stijn Mackay, Tara M. Tol, Johanna A.M.G. van Delden, Otto M. van Lienden, Krijn P. Nio, Chung Y. Phoa, Saffire S.K.S. Fockens, Paul van Hooft, Jeanin E. Verheij, Joanne Wilmink, Johanna W. van Gulik, Thomas M. Gouma, Dirk J. Busch, Olivier R. Besselink, Marc G. |
| description | Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.
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.
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 |
| doi_str_mv | 10.1016/j.hpb.2018.10.020 |
| format | Article |
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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.
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).
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.]]></description><identifier>ISSN: 1365-182X</identifier><identifier>EISSN: 1477-2574</identifier><identifier>DOI: 10.1016/j.hpb.2018.10.020</identifier><identifier>PMID: 30606684</identifier><language>eng</language><publisher>England: Elsevier Ltd</publisher><subject>Age Factors ; Aged ; Chemotherapy, Adjuvant ; Clinical Decision-Making ; Databases, Factual ; Failure to Rescue, Health Care - trends ; Female ; Hospital Mortality - trends ; Hospitals, High-Volume ; Humans ; Length of Stay - trends ; Male ; Middle Aged ; Neoadjuvant Therapy - trends ; Neoplasm Staging ; Pancreatic Neoplasms - mortality ; Pancreatic Neoplasms - pathology ; Pancreatic Neoplasms - surgery ; Pancreaticoduodenectomy - adverse effects ; Pancreaticoduodenectomy - mortality ; Pancreaticoduodenectomy - trends ; Patient Selection ; Postoperative Complications - etiology ; Practice Patterns, Physicians' - trends ; Retrospective Studies ; Risk Assessment ; Risk Factors ; Time Factors ; Vascular Surgical Procedures - adverse effects ; Vascular Surgical Procedures - mortality ; Vascular Surgical Procedures - trends</subject><ispartof>HPB (Oxford, England), 2019-07, Vol.21 (7), p.865-875</ispartof><rights>2018 International Hepato-Pancreato-Biliary Association Inc.</rights><rights>Copyright © 2018 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.</rights><lds50>peer_reviewed</lds50><woscitedreferencessubscribed>false</woscitedreferencessubscribed><citedby>FETCH-LOGICAL-c419t-d6df32d928a2e83b4feed5bac7ae5aef161ce8b7d56103bc9de3efb1cb7579d3</citedby><cites>FETCH-LOGICAL-c419t-d6df32d928a2e83b4feed5bac7ae5aef161ce8b7d56103bc9de3efb1cb7579d3</cites></display><links><openurl>$$Topenurl_article</openurl><openurlfulltext>$$Topenurlfull_article</openurlfulltext><thumbnail>$$Tsyndetics_thumb_exl</thumbnail><link.rule.ids>314,780,784,27924,27925</link.rule.ids><backlink>$$Uhttps://www.ncbi.nlm.nih.gov/pubmed/30606684$$D View this record in MEDLINE/PubMed$$Hfree_for_read</backlink></links><search><creatorcontrib>van Roessel, Stijn</creatorcontrib><creatorcontrib>Mackay, Tara M.</creatorcontrib><creatorcontrib>Tol, Johanna A.M.G.</creatorcontrib><creatorcontrib>van Delden, Otto M.</creatorcontrib><creatorcontrib>van Lienden, Krijn P.</creatorcontrib><creatorcontrib>Nio, Chung Y.</creatorcontrib><creatorcontrib>Phoa, Saffire S.K.S.</creatorcontrib><creatorcontrib>Fockens, Paul</creatorcontrib><creatorcontrib>van Hooft, Jeanin E.</creatorcontrib><creatorcontrib>Verheij, Joanne</creatorcontrib><creatorcontrib>Wilmink, Johanna W.</creatorcontrib><creatorcontrib>van Gulik, Thomas M.</creatorcontrib><creatorcontrib>Gouma, Dirk J.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><title>Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies</title><title>HPB (Oxford, England)</title><addtitle>HPB (Oxford)</addtitle><description><![CDATA[Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.
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.
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).
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.]]></description><subject>Age Factors</subject><subject>Aged</subject><subject>Chemotherapy, Adjuvant</subject><subject>Clinical Decision-Making</subject><subject>Databases, Factual</subject><subject>Failure to Rescue, Health Care - trends</subject><subject>Female</subject><subject>Hospital Mortality - trends</subject><subject>Hospitals, High-Volume</subject><subject>Humans</subject><subject>Length of Stay - trends</subject><subject>Male</subject><subject>Middle Aged</subject><subject>Neoadjuvant Therapy - trends</subject><subject>Neoplasm Staging</subject><subject>Pancreatic Neoplasms - mortality</subject><subject>Pancreatic Neoplasms - pathology</subject><subject>Pancreatic Neoplasms - surgery</subject><subject>Pancreaticoduodenectomy - adverse effects</subject><subject>Pancreaticoduodenectomy - mortality</subject><subject>Pancreaticoduodenectomy - trends</subject><subject>Patient Selection</subject><subject>Postoperative Complications - etiology</subject><subject>Practice Patterns, Physicians' - trends</subject><subject>Retrospective Studies</subject><subject>Risk Assessment</subject><subject>Risk Factors</subject><subject>Time Factors</subject><subject>Vascular Surgical Procedures - adverse effects</subject><subject>Vascular Surgical Procedures - mortality</subject><subject>Vascular Surgical Procedures - trends</subject><issn>1365-182X</issn><issn>1477-2574</issn><fulltext>true</fulltext><rsrctype>article</rsrctype><creationdate>2019</creationdate><recordtype>article</recordtype><sourceid>EIF</sourceid><recordid>eNp9kL1u3DAQhIkgRvz7AGkClml0JimKkpAqMGzHgAE3LtwR1HJ14UESFVIy4rf3Hu6S0tXucGcG4MfYVyk2Ukhzvdv8nruNErIhvRFKfGJnUtd1oapaf6a9NFUhG_Vyys5z3gmhKNZ-YaelMMKYRp-x-DDODhYee45_Zzf5MG15oAFuCXHKPE48r2lLeuB0Jg1xiAcd1wXiiOTnUpeaAwUQ1iW8IqcuSOiW6NfocUJY4hgwX7KT3g0Zr47zgj3f3T7f_Coen-4fbn4-FqBluxTe-L5UvlWNU9iUne4RfdU5qB1WDntpJGDT1b4yUpQdtB5L7DsJXV3VrS8v2PdD7ZzinxXzYseQAYfBTRjXbJU0WgqhTUtWebBCijkn7O2cwujSm5XC7jHbnSXMdo95_0SYKfPtWL92I_r_iX9cyfDjYED642vAZDMEnAB9SITC-hg-qH8Hr7OQ3w</recordid><startdate>201907</startdate><enddate>201907</enddate><creator>van Roessel, Stijn</creator><creator>Mackay, Tara M.</creator><creator>Tol, Johanna A.M.G.</creator><creator>van Delden, Otto M.</creator><creator>van Lienden, Krijn P.</creator><creator>Nio, Chung Y.</creator><creator>Phoa, Saffire S.K.S.</creator><creator>Fockens, Paul</creator><creator>van Hooft, Jeanin E.</creator><creator>Verheij, Joanne</creator><creator>Wilmink, Johanna W.</creator><creator>van Gulik, Thomas M.</creator><creator>Gouma, Dirk J.</creator><creator>Busch, Olivier R.</creator><creator>Besselink, Marc G.</creator><general>Elsevier Ltd</general><scope>CGR</scope><scope>CUY</scope><scope>CVF</scope><scope>ECM</scope><scope>EIF</scope><scope>NPM</scope><scope>AAYXX</scope><scope>CITATION</scope><scope>7X8</scope></search><sort><creationdate>201907</creationdate><title>Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies</title><author>van Roessel, Stijn ; Mackay, Tara M. ; Tol, Johanna A.M.G. ; van Delden, Otto M. ; van Lienden, Krijn P. ; Nio, Chung Y. ; Phoa, Saffire S.K.S. ; Fockens, Paul ; van Hooft, Jeanin E. ; Verheij, Joanne ; Wilmink, Johanna W. ; van Gulik, Thomas M. ; Gouma, Dirk J. ; Busch, Olivier R. ; Besselink, Marc G.</author></sort><facets><frbrtype>5</frbrtype><frbrgroupid>cdi_FETCH-LOGICAL-c419t-d6df32d928a2e83b4feed5bac7ae5aef161ce8b7d56103bc9de3efb1cb7579d3</frbrgroupid><rsrctype>articles</rsrctype><prefilter>articles</prefilter><language>eng</language><creationdate>2019</creationdate><topic>Age Factors</topic><topic>Aged</topic><topic>Chemotherapy, Adjuvant</topic><topic>Clinical Decision-Making</topic><topic>Databases, Factual</topic><topic>Failure to Rescue, Health Care - trends</topic><topic>Female</topic><topic>Hospital Mortality - trends</topic><topic>Hospitals, High-Volume</topic><topic>Humans</topic><topic>Length of Stay - trends</topic><topic>Male</topic><topic>Middle Aged</topic><topic>Neoadjuvant Therapy - trends</topic><topic>Neoplasm Staging</topic><topic>Pancreatic Neoplasms - mortality</topic><topic>Pancreatic Neoplasms - pathology</topic><topic>Pancreatic Neoplasms - surgery</topic><topic>Pancreaticoduodenectomy - adverse effects</topic><topic>Pancreaticoduodenectomy - mortality</topic><topic>Pancreaticoduodenectomy - trends</topic><topic>Patient Selection</topic><topic>Postoperative Complications - etiology</topic><topic>Practice Patterns, Physicians' - trends</topic><topic>Retrospective Studies</topic><topic>Risk Assessment</topic><topic>Risk Factors</topic><topic>Time Factors</topic><topic>Vascular Surgical Procedures - adverse effects</topic><topic>Vascular Surgical Procedures - mortality</topic><topic>Vascular Surgical Procedures - trends</topic><toplevel>peer_reviewed</toplevel><toplevel>online_resources</toplevel><creatorcontrib>van Roessel, Stijn</creatorcontrib><creatorcontrib>Mackay, Tara M.</creatorcontrib><creatorcontrib>Tol, Johanna A.M.G.</creatorcontrib><creatorcontrib>van Delden, Otto M.</creatorcontrib><creatorcontrib>van Lienden, Krijn P.</creatorcontrib><creatorcontrib>Nio, Chung Y.</creatorcontrib><creatorcontrib>Phoa, Saffire S.K.S.</creatorcontrib><creatorcontrib>Fockens, Paul</creatorcontrib><creatorcontrib>van Hooft, Jeanin E.</creatorcontrib><creatorcontrib>Verheij, Joanne</creatorcontrib><creatorcontrib>Wilmink, Johanna W.</creatorcontrib><creatorcontrib>van Gulik, Thomas M.</creatorcontrib><creatorcontrib>Gouma, Dirk J.</creatorcontrib><creatorcontrib>Busch, Olivier R.</creatorcontrib><creatorcontrib>Besselink, Marc G.</creatorcontrib><collection>Medline</collection><collection>MEDLINE</collection><collection>MEDLINE (Ovid)</collection><collection>MEDLINE</collection><collection>MEDLINE</collection><collection>PubMed</collection><collection>CrossRef</collection><collection>MEDLINE - Academic</collection><jtitle>HPB (Oxford, England)</jtitle></facets><delivery><delcategory>Remote Search Resource</delcategory><fulltext>fulltext</fulltext></delivery><addata><au>van Roessel, Stijn</au><au>Mackay, Tara M.</au><au>Tol, Johanna A.M.G.</au><au>van Delden, Otto M.</au><au>van Lienden, Krijn P.</au><au>Nio, Chung Y.</au><au>Phoa, Saffire S.K.S.</au><au>Fockens, Paul</au><au>van Hooft, Jeanin E.</au><au>Verheij, Joanne</au><au>Wilmink, Johanna W.</au><au>van Gulik, Thomas M.</au><au>Gouma, Dirk J.</au><au>Busch, Olivier R.</au><au>Besselink, Marc G.</au><format>journal</format><genre>article</genre><ristype>JOUR</ristype><atitle>Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies</atitle><jtitle>HPB (Oxford, England)</jtitle><addtitle>HPB (Oxford)</addtitle><date>2019-07</date><risdate>2019</risdate><volume>21</volume><issue>7</issue><spage>865</spage><epage>875</epage><pages>865-875</pages><issn>1365-182X</issn><eissn>1477-2574</eissn><abstract><![CDATA[Over the years, high-volume pancreatic centers expanded their indications for pancreatoduodenectomy (PD) but with unknown impact on surgical and oncological outcome.
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.
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).
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.]]></abstract><cop>England</cop><pub>Elsevier Ltd</pub><pmid>30606684</pmid><doi>10.1016/j.hpb.2018.10.020</doi><tpages>11</tpages></addata></record> |
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| subjects | Age Factors Aged Chemotherapy, Adjuvant Clinical Decision-Making Databases, Factual Failure to Rescue, Health Care - trends Female Hospital Mortality - trends Hospitals, High-Volume Humans Length of Stay - trends Male Middle Aged Neoadjuvant Therapy - trends Neoplasm Staging Pancreatic Neoplasms - mortality Pancreatic Neoplasms - pathology Pancreatic Neoplasms - surgery Pancreaticoduodenectomy - adverse effects Pancreaticoduodenectomy - mortality Pancreaticoduodenectomy - trends Patient Selection Postoperative Complications - etiology Practice Patterns, Physicians' - trends Retrospective Studies Risk Assessment Risk Factors Time Factors Vascular Surgical Procedures - adverse effects Vascular Surgical Procedures - mortality Vascular Surgical Procedures - trends |
| title | Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies |
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