title: Time trends in the treatment and prognosis of resectable pancreatic cancer in a large tertiary referral centre.
abstract: OBJECTIVE
  Mortality in pancreatic cancer has remained unchanged over the last 20-30 years. The aim of the present study was to analyse survival trends in a selected population of patients submitted to resection for pancreatic cancer at a single institution.
  
  
  METHODS
  Included were 544 patients who underwent pancreatectomy for pancreatic cancer between 1990 and 2009. Patients were categorized into two subgroups according to the decade in which resection was performed (1990-1999 and 2000-2009). Predictors of survival were analysed using univariate and multivariate analyses.
  
  
  RESULTS
  Totals of 114 (21%) and 430 (79%) resections were carried out during the periods 1990-1999 and 2000-2009, respectively (P < 0.0001). Hospital length of stay (16 days versus 10 days; P < 0.001) and postoperative mortality (3% versus 1%; P = 0.160) decreased over time. Median disease-specific survival significantly increased from 16 months in the first period to 29 months in the second period (P < 0.001). Following multivariate analysis, poorly differentiated tumour [hazard ratio (HR) 3.1, P < 0.001], lymph node metastases (HR = 1.9, P < 0.001), macroscopically positive margin (R2) resection (HR = 3.2, P < 0.0001), no adjuvant therapy (HR = 1.6, P < 0.001) and resection performed in the period 1990-1999 (HR = 2.18, P < 0.001) were significant independent predictors of a poor outcome.
  
  
  CONCLUSIONS
  Longterm survival after surgery for pancreatic cancer significantly improved over the period under study. Better patient selection and the routine use of adjuvant therapy may account for this improvement.
authors.affiliation: Department of Surgery, University of Verona, Verona, Italy.
authors.forename: Giuliano
authors.initials: G
authors.lastname: Barugola
authors.forename: Stefano
authors.initials: S
authors.lastname: Partelli
authors.forename: Stefano
authors.initials: S
authors.lastname: Crippa
authors.forename: Giovanni
authors.initials: G
authors.lastname: Butturini
authors.forename: Roberto
authors.initials: R
authors.lastname: Salvia
authors.forename: Nora
authors.initials: N
authors.lastname: Sartori
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.forename: Paolo
authors.initials: P
authors.lastname: Pederzoli
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D017024:Chemotherapy, Adjuvant; D016009:Chi-Square Distribution; D005260:Female; D006801:Humans; D007558:Italy; D053208:Kaplan-Meier Estimate; D007902:Length of Stay; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality / Q000639:trends*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012307:Risk Factors; D062606:Tertiary Care Centers / Q000639:trends*; D013997:Time Factors; D016896:Treatment Outcome