title: Determination of factors predictive of outcome for patients undergoing a pancreaticoduodenectomy of pancreatic head ductal adenocarcinomas.
abstract: BACKGROUND
  A pancreaticoduodenectomy is the reference treatment for a resectable pancreatic head ductal adenocarcinoma. The probability of 5-year survival in patients undergoing such treatment is 5-25% and is associated with relatively high peri-operative morbidity and mortality. The objective of the present study was to evaluate risk factors predictive of outcome for patients undergoing a pancreaticoduodenectomy for a pancreatic adenocarcinoma.
  
  
  METHODS
  This retrospective analysis incorporated data from the Vancouver General Hospital and the British Columbia Cancer Agency (BCCA) from 1999-2007.
  
  
  RESULTS
  The 5-year survival of 100 patients was 12% with a median survival of 16.5 months. Ninety-day mortality was 7%. Predictors of 90-day mortality included age ≥ 80 years (P < 0.001) and an American Society of Anesthesiologists (ASA) score = 3 (P= 0.012) by univariate analysis and age ≥80 years (P < 0.001) by multivariate analysis. The identifiable predictive factor for poor 5-year survival was an ASA score = 3 (P= 0.043) whereas a Dindo-Clavien surgical complication grade ≥ 3 was associated with a worse outcome (P= 0.013). Referral to the BCCA was associated with a favourable 5-year survival (P= 0.001).
  
  
  CONCLUSIONS
  The present study identifies risk factors for patient selection to enhance survival benefit in this patient population.
authors.affiliation: Department of Surgery, University of British Columbia, and the BC Cancer Agency, Department of Cancer Surveillance & Outcomes, Surgical Oncology Network, 2775 Laurel Street, Vancouver, BC, Canada.
authors.forename: Gareth
authors.initials: G
authors.lastname: Eeson
authors.forename: Nicolas
authors.initials: N
authors.lastname: Chang
authors.forename: Colleen E
authors.initials: CE
authors.lastname: McGahan
authors.forename: Fareeza
authors.initials: F
authors.lastname: Khurshed
authors.forename: Andrzej K
authors.initials: AK
authors.lastname: Buczkowski
authors.forename: Charles H
authors.initials: CH
authors.lastname: Scudamore
authors.forename: Garth L
authors.initials: GL
authors.lastname: Warnock
authors.forename: Stephen W
authors.initials: SW
authors.lastname: Chung
mesh_terms: D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D001955:British Columbia; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D015999:Multivariate Analysis; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018570:Risk Assessment; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome