title: Surgical management in patients with pancreatic cancer: a Queensland perspective.
abstract: BACKGROUND
  Little has been published regarding presenting symptoms, investigations and outcomes for patients with pancreatic cancer in Australia. Data from a series of patients undergoing attempted resection in Queensland, Australia, are presented with the aim of assisting development of consistent strategies in disease management.
  
  
  METHODS
  We reviewed the medical records of 121 patients who underwent attempted surgical resection and who took part in a case-control study between 2007 and 2009. Information relating to symptoms, investigations, surgical procedures and outcomes was captured.
  
  
  RESULTS
  The mean age was 63 years and 60% were men. The most common presenting symptoms were jaundice (64%) and pain (63%). Over 80% of patients had multiple imaging investigations or laparoscopy prior to surgery. Seventy-eight patients (64%) had a completed resection and 23% of these had involved margins. The presence of metastases and/or involvement of vessels or adjacent structures precluded resection in the remaining patients. The 1-year survival for patients whose resections were completed was 77% compared with 51% for those whose tumours were not resectable (P = 0.004). There was no 30-day mortality and 68% of patients were alive 1 year after diagnosis. Resections were performed in 11 different hospitals but over 90% of patients underwent their surgery in one of five high-volume centres.
  
  
  CONCLUSIONS
  The Queensland experience is consistent with that reported internationally. A significant proportion of attempted resections was not completed because preoperative staging underestimated disease extent. Most patients with potentially resectable disease are being treated in high-volume centres.
authors.affiliation: Queensland Institute of Medical Research, Brisbane, Queensland, Australia.
authors.forename: Neil
authors.initials: N
authors.lastname: Wylie
authors.forename: Reza
authors.initials: R
authors.lastname: Adib
authors.forename: Andrew P
authors.initials: AP
authors.lastname: Barbour
authors.forename: Jonathan
authors.initials: J
authors.lastname: Fawcett
authors.forename: Alexander
authors.initials: A
authors.lastname: Hill
authors.forename: Stephen
authors.initials: S
authors.lastname: Lynch
authors.forename: Ian
authors.initials: I
authors.lastname: Martin
authors.forename: Thomas R
authors.initials: TR
authors.lastname: O'Rourke
authors.forename: Harald
authors.initials: H
authors.lastname: Puhalla
authors.forename: Leigh
authors.initials: L
authors.lastname: Rutherford
authors.forename: Kellee
authors.initials: K
authors.lastname: Slater
authors.forename: David C
authors.initials: DC
authors.lastname: Whiteman
authors.forename: Rachel E
authors.initials: RE
authors.lastname: Neale
mesh_terms: D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000401:mortality / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011793:Queensland / Q000453:epidemiology
keywords: Australia; general surgery; neoplasms; pancreatic neoplasms; therapeutics