title: Total pancreatectomy for pancreatic ductal adenocarcinoma: review of the National Cancer Data Base.
abstract: BACKGROUND
  Total pancreatectomy is infrequently performed for pancreatic cancer. Perceived operative mortality and questionable survival benefit deter many surgeons. Clinical outcomes, described in single-center series, remain largely unknown.
  
  
  METHODS
  The National Cancer Database was queried for cases of pancreatic ductal adenocarcinoma undergoing total pancreatectomy (1998-2011). Univariate survival analyses were performed for 21 variables: demographic (8), tumor characteristics (5), surgery outcomes (6), and adjuvant therapy (2). The Log-rank test of differences in Kaplan-Meier survival curves was used for categorical variables. Variables with p < 0.05 were included in a multivariate analysis. Cox proportional hazards regression was used to analyze continuous variables and multivariate models.
  
  
  RESULTS
  2582 patients with staging and survival data made up the study population. 30-day mortality was 5.5%. Median overall survival was 15 months, with 1, 3, and 5-year survival rates of 60%, 22%, and 13%, respectively. Age, facility type, tumor size and grade, lymph node positivity, margin positivity, and adjuvant therapy significantly impacted survival in multivariate analysis.
  
  
  CONCLUSIONS
  Although total pancreatectomy is a reasonable option for selected patients with pancreatic ductal adenocarcinoma, survival of the entire group is limited. Operative mortality is improved from prior reports. Greater survival benefits were seen in younger patients with smaller, node negative tumors resected with negative margins in academic research centers.
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States.
authors.forename: W Cory
authors.initials: WC
authors.lastname: Johnston
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States.
authors.forename: Helena M
authors.initials: HM
authors.lastname: Hoen
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, United States.
authors.forename: Maria A
authors.initials: MA
authors.lastname: Cassera
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, United States.
authors.forename: Pippa H
authors.initials: PH
authors.lastname: Newell
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, United States.
authors.forename: Chet W
authors.initials: CW
authors.lastname: Hammill
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, United States. Electronic address: phansen@orclinic.com.
authors.forename: Paul D
authors.initials: PD
authors.lastname: Hansen
authors.affiliation: Hepatobiliary and Pancreatic Surgery Program, Providence Portland Medical Center, Portland, OR, United States; Gastrointestinal and Minimally Invasive Surgery Division, The Oregon Clinic, Portland, OR, United States.
authors.forename: Ronald F
authors.initials: RF
authors.lastname: Wolf
mesh_terms: D000046:Academic Medical Centers; D000328:Adult; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000556:secondary / Q000601:surgery*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008875:Middle Aged; D015999:Multivariate Analysis; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D012307:Risk Factors; D013997:Time Factors; D016896:Treatment Outcome; D047368:Tumor Burden; D014481:United States