title: Improved survival following pancreaticoduodenectomy to treat adenocarcinoma of the pancreas: the influence of operative blood loss.
abstract: OBJECTIVE
  Although the safety of pancreaticoduodenectomy has notably improved over the past several decades, the reported survival of patients with pancreatic cancer remains poor. We hypothesized that, in recent years, the survival of patients with pancreatic adenocarcinoma following pancreaticoduodenectomy has substantially improved.
  
  
  METHODS
  Retrospective case series.
  
  
  METHODS
  Major academic medical and pancreatic surgery center.
  
  
  METHODS
  A total of 182 consecutive patients underwent pancreaticoduodenectomy for various diagnoses between 1987 and 2005. Patients from 1987-1995 were compared with patients from 1996-2005.
  
  
  METHODS
  Pancreaticoduodenectomy for patients with a diagnosis of pancreatic adenocarcinoma.
  
  
  METHODS
  Survival after pancreaticoduodenectomy and patient outcomes.
  
  
  RESULTS
  During the time period analyzed, 182 patients underwent pancreaticoduodenectomy to treat ductal adenocarcinoma. There were no operative deaths, and 86.3% of patients had an R0 resection. The 5-year survival rate for the entire group was 27.4%. However, survival improved from 15.8% to 35.5% during the study period. Both groups had equivalent demographic and pathological characteristics, and the only predictors of poor survival in multivariate analysis were operative blood loss of more than 400 mL (hazard ratio, 2.17), poorly differentiated tumors (3.03), lymph node metastases (1.92), perineural invasion (2.66), and undergoing an operation before 1996 (1.42).
  
  
  CONCLUSIONS
  The survival rate for patients undergoing pancreaticoduodenectomy to treat pancreatic cancer has substantially improved. This finding is partially owing to improved operative technique and limited operative blood loss.
authors.affiliation: Section of Gastrointestinal Surgery, Department of Surgery, David Geffen School of Medicine, University of California, Los Angeles 90095-6904, USA.
authors.forename: Kevork K
authors.initials: KK
authors.lastname: Kazanjian
authors.forename: O Joe
authors.initials: OJ
authors.lastname: Hines
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: Diana Y
authors.initials: DY
authors.lastname: Yoon
authors.forename: Galen
authors.initials: G
authors.lastname: Cortina
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000368:Aged; D016063:Blood Loss, Surgical / Q000401:mortality*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D012189:Retrospective Studies; D016019:Survival Analysis; D016896:Treatment Outcome