COMPLICATIONS AND OUTCOMES IN THE TREATMENT OF PANCREATIC ADENOCARCINOMA IN THE UNITED-STATES VETERAN

BACKGROUND: Treatments for carcinoma of the pancreas have wide variati ons in reported complications and results. STUDY DESIGN: A population- based retrospective analysis of invasive treatments for carcinoma of t he pancreas in all United States Department of Veterans Affairs hospit als was conducted using computerized patient files from 1987 to 1991. RESULTS: One thousand nine hundred sixty-four patients (99 percent mal e) were classified by the most aggressive treatment: 327 patients had pancreatic resections, While 1,180 had operative biliary or gastric by passes, and 457 had percutaneous or endoscopic biliary intubations. Re section was associated with the lowest 30-day mortality rate (12 perce nt) and the longest mean survival period (449 days), but also the high est complication rate (37 percent) and mean period of hospitalization (53 days), with a projected five-year survival rate of 12 percent. Aft er operative bypass, the 30-day mortality rate was 19 percent and the mean survival period was 234 days. Corresponding values after nonopera tive biliary intubation were 32 percent and 223 days. Results were ind ependent of hospital size and university affiliation, but were poorer in patients more than 60 years of age. CONCLUSIONS: This national seri es of therapy for carcinoma of the pancreas demonstrates that resectio n yielded a significantly longer survival period, with a lower mortali ty rate than other treatments. The results were consistent across cate gories of hospital size or university affiliation.