Surgical management in patients with pancreatic cancer: a Queensland perspective

Authors


  • N. Wylie MBBS; R. Adib FRACS, FRCSEd; A. P. Barbour MBBS (Hons), FRACS, PhD; J. Fawcett DPhil, FRCS, FRACS; A. Hill BA; S. Lynch MBBS, FRACS; I. Martin MBBS, FRACS; T. R. O'Rourke MBBS, BMedSc, FRACS; H. Puhalla MD (General Surgery); L. Rutherford MBBS, FRACS; K. Slater MBBS (Hons), FRACS; D. C. Whiteman MBBS, PhD; R. E. Neale PhD.
  • Queensland Pancreatic Cancer Study Group: Chief Investigators: Rachel Neale; Jonathan Fawcett; Lin Fritschi; Harvey Risch; Penelope Webb; David Whiteman. Clinical Collaborators: Rick Abraham; Reza Adib; Mark Appleyard; John Avramovic; Andrew Barbour; Ian Baxter; Matthew Burge; Boris Chern; Michelle Cronk; Ben Devereaux; Paul Eliadis; Robert Finch; John Gibbons; David Grimes; Brendan Hanrahan; George Hopkins; Luke Hourigan; Sybil Kellner; Laurent Layani; Stephen Lynch; Ian Martin; Judith McEniery; Lesley Nathanson; Nicholas O'Rourke; Tom O'Rourke; Harald Puhalla; Matthew Remedios; Leigh Rutherford; Sabe Sabesan; Candice Silverman; Kellee Slater; Craig Sommerville; Paul Vasey; David Wyld; Johannes Wittman; Louise Welch; Shinn Yeung.

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.

Conclusion

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.

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