Dramatic improvements in outcome following pancreatoduodenectomy for pancreatic and periampullary cancers.

Autor: Xu H; Department of Thoracic Surgery, Fujian Medical University Union Hospital, Fuzhou, China.; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Bretthauer M; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway., Fang F; Institute of Environmental Medicine, Karolinska Institutet, Stockholm, Sweden., Ye W; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden.; School of Public Health, Fujian Medical University, Fuzhou, China., Yin L; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden., Adami HO; Department of Medical Epidemiology and Biostatistics, Karolinska Institutet, Stockholm, Sweden. hans-olov.adami@ki.se.; Clinical Effectiveness Research Group, Institute of Health and Society, University of Oslo, Oslo, Norway. hans-olov.adami@ki.se.; Department of Epidemiology, Harvard T.H. Chan School of Public Health, Boston, MA, USA. hans-olov.adami@ki.se.
Jazyk: angličtina
Zdroj: British journal of cancer [Br J Cancer] 2024 Sep; Vol. 131 (4), pp. 747-754. Date of Electronic Publication: 2024 Jun 27.
DOI: 10.1038/s41416-024-02757-w
Abstrakt: Background: Pancreatoduodenectomy is the only cure for cancers of the pancreas and the periampullary region but has considerable operative complications and uncertain prognosis. Our goal was to analyse temporal improvements and provide contemporary population-based benchmarks for outcomes following pancreatoduodenectomy.
Methods: We empanelled a cohort comprising all patients in Sweden with pancreatic or periampullary cancer treated with pancreatoduodenectomy from 1964 to 2016 and achieved complete follow-up through 2016. We analysed postoperative deaths and disease-specific net survival.
Results: We analysed 5923 patients with cancer of the pancreas (3876), duodenum (444), bile duct (504), or duodenal papilla (963) who underwent classic (3332) or modified (1652) Whipple's procedure or total pancreatectomy (803). Postoperative deaths declined from 17.2% in the 1960s to 1.6% in the contemporary time period (2010-2016). For all four cancer types, median, 1-year and 5-year survival improved substantially over time. Among patients operated between 2010 and 2016, 5-year survival was 29.0% (95% confidence interval (CI): 25.5, 33.0) for pancreatic cancer, 71.2% (95% CI: 62.9, 80.5) for duodenal cancer, 30.8% (95% CI: 23.0, 41.3) for bile duct cancer, and 62.7% (95% CI: 55.5, 70.8) for duodenal papilla cancer.
Conclusion: There is a continuous and substantial improvement in the benefit-harm ratio after pancreatoduodenectomy for cancer.
(© 2024. The Author(s).)
Databáze: MEDLINE
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