Complications and outcomes in the treatment of pancreatic adenocarcinoma in the United States veteran.

Background: Treatments for carcinomma of the pancreas have wide variations in reported complications and results.

Study Design: A population-based retrospective analysis of invasive treatments for carcinoma of the pancreas in all United States Department of Veterans Affairs hospitals was conducted using computerized patients files from 1987 to 1991.

Results: One thousand nine hundred sixty-four patients (99 percent male) were classified by the most aggressive treatment: 327 patients had pancreatic resections, while 1,180 had operative biliary or gastric bypasses, and 457 had percutaneous or endoscopic biliary intubations. Resection was associated with the lowest 30-day mortality rate (12 percent) and the longest mean survival period (449 days), but also the highest complication rate (37 percent) and mean period of hospitalization (53 days), with a projected five-year survival rate of 12 percent. After operative bypass, the 30-day mortality rate was 19 percent and the mean survival period was 234 days. Corresponding values after nonoperative biliary intubation were 32 percent and 223 days. Results were independent of hospital size and university affiliation, but were poorer in patients more than 60 years of age.

Conclusions: This national series of therapy for carcinoma of the pancreas demonstrates that resection yielded a significantly longer survival period, with a lower mortality rate than other treatments. The results were consistent across categories of hospital size or university affiliation.