title: Has survival following pancreaticoduodenectomy for pancreas adenocarcinoma improved over time?
abstract: BACKGROUND
  Survival following resection of pancreas cancer is poor. It is uncertain whether outcome improved overtime. Due to the recent advances in surgical techniques, diagnostic evaluation, and systemic treatment, we sought to evaluate pancreas cancer outcome over time.
  
  
  METHODS
  Prospectively collected data on patients who underwent pancreaticoduodenectomy for pathologically confirmed pancreatic adenocarcinoma from 1999 to 2012 were analyzed. Perioperative and long-term outcomes were analyzed, comparing patients from era 1 (1999-2005) to patients from era 2 (2006-2012).
  
  
  RESULTS
  Two-hundred sixteen patients were evaluated, including 76 in era 1 and 140 in era 2. There was no difference in 30-day mortality (1.3%, era 1 vs. 1.4%, era 2; P = 0.95) or rates of overall 30-day morbidity (49%, era 1 vs. 62%, era 2; P = 0.06). On multivariable analysis after adjusting for perineural invasion, lymphovascular invasion, margin status, EBL, and venous resection, there was no difference in survival between eras (HR = 0.81, P = 0.27, CI = 0.57-1.16).
  
  
  CONCLUSIONS
  After adjusting for clinicopathological features, there was no association of improved outcome over time. However, despite an increasing prevalence of anatomically advanced and histologically aggressive tumors, perioperative outcomes such as blood loss and margin negativity improved over time, with no increase in 30-day mortality.
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Ahmed I
authors.initials: AI
authors.lastname: Salem
authors.affiliation: University of Wisconsin School of Medicine and Public Health, Madison, Wisconsin.
authors.forename: Mina
authors.initials: M
authors.lastname: Alfi
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Emily
authors.initials: E
authors.lastname: Winslow
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Clifford S
authors.initials: CS
authors.lastname: Cho
authors.affiliation: Department of Surgery, University of Wisconsin Hospital and Clinics, Madison, Wisconsin.
authors.forename: Sharon M
authors.initials: SM
authors.lastname: Weber
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000066491:Clinical Decision-Making; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D060787:Neoplasm Grading; D010190:Pancreatic Neoplasms / Q000401:mortality* / Q000473:pathology / Q000601:surgery; D016577:Pancreaticoduodenectomy / Q000401:mortality*; D011183:Postoperative Complications; D011379:Prognosis; D011446:Prospective Studies; D015996:Survival Rate; D013997:Time Factors
keywords: pancreas cancer; pancreaticoduodenectomy; survival