Pancreatic Cancer in Sweden 1980-2000: A Population-Based Study of Hospitalized Patients Concerning Time Trends in Curative Surgery and Other Interventional Therapies

Progress has been made during the last few decades in the treatment of patients with pancreatic cancer. In this population-based study, the time trends in curative surgery and the choice of palliative invasive therapies in Sweden over two decades are analyzed. Patients treated for pancreatic carcinoma in Sweden during 1980-2000 were identified in the Swedish Hospital Discharge Register and the Cancer Register. These data were matched with those in the Register of Causes of Death in Sweden. Data were identified and analyzed for 16,758 patients for three periods: 1980-1986 (n = 5775), 1987-1993 (n = 6096), and 1994-2000 (n = 4887). The rate of pancreatic resection increased 7.2%, 10.9%, and 15.1% (P < 0.0001) during the three respective periods. Palliative interventions decreased from 46.8% in the first period to 41.7% in the last period. On comparing the first and the last periods, biliary bypass operations were found to decrease (from 45.9% to 18.1%), as well as gastric bypass procedures (from 33.8% to 22.8%; P < 0.0001). Interventions by percutaneous transhepatic cholangiography (PTC) remained constant (10%-11%). Endoscopic therapy increased from 10.8% to 49.0%, as did the number of procedures per patient, from 1.3 to 1.7 (P < 0.0001) in the first and last periods, respectively. In 1980, the mean hospital stay was 40 days after resection and 30 days after palliative intervention. In 2000, the corresponding numbers were 26 days and 18 days (P < 0.001), respectively. During the past two decades, the rate of pancreatic resections in Sweden increased significantly. There was also a dramatic drop in palliative open surgery and a simultaneous increase in endoscopic interventions. Hospital stays decreased by more than a third.