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Factors influencing survival in patients undergoing palliative bypass for pancreatic adenocarcinoma
Author(s) -
Gray Phillip J.,
Wang Jingya,
Pawlik Timothy M.,
Edil Barish H.,
Schulick Richard,
Hruban Ralph H.,
Dao Harry,
Cameron John,
Wolfgang Christopher,
Herman Joseph M.
Publication year - 2012
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.23047
Subject(s) - medicine , adenocarcinoma , univariate analysis , palliative care , vomiting , pancreatic cancer , nausea , surgery , gastroenterology , multivariate analysis , cancer , nursing
Purpose The purpose of this study is to identify factors predictive of early mortality following palliative bypass in patients with previously unsuspected advanced pancreatic adenocarcinoma to provide a basis for the selection of appropriate therapies. Methods All patients with pancreatic adenocarcinoma who underwent a bypass procedure at our institution between 9/30/1994 and 1/31/2006 were reviewed. Patients with peri‐operative mortality were excluded from the analysis. Univariate analysis was performed on peri‐operative data to identify factors associated with early mortality (death within 6 months of surgery). Patients having multiple risk factors were assigned an overall prognostic score based on the sum of these factors. Results Of the 397 patients with pancreatic adenocarcinoma analyzed, four factors were found to predict early mortality following palliative bypass: Presence of distant metastatic disease (HR 2.59, P < 0.0001), poor tumor differentiation (HR 1.71, P = 0.009), severe pre‐operative nausea and vomiting (HR 1.48, P = 0.013), and lack of previous placement of a biliary stent (HR 1.36, P = 0.048). Patients with a prognostic score of 0 were significantly more likely to survive past 6 months than patients with a prognostic score of 1 (HR 2.71, P < 0.0001), 2 (HR 3.70, P < 0.0001), or ≥3 (HR 5.63, P < 0.0001). Conclusions In a cohort of patients undergoing a palliative bypass procedure, specific peri‐operative factors can be used to identify patients who are at risk of early mortality. These factors may be helpful in selecting appropriate interventions for this group of patients. J. Surg. Oncol. 2012; 106:66–71. © 2012 Wiley Periodicals, Inc.