Pancreatic cancer treatment in the U.S. veteran from 1987 to 1991: effect of tumor stage on survival.

To assess the outcomes after pancreatic cancer treatment in a nationwide hospital system, patients treated in Department of Veterans Affairs (DVA) hospitals from 1987 to 1991 were studied by tumor stage, the most significant reported influence on survival. Tumor registrars from DVA hospitals provided information that allowed TNM staging in 598 patients, and duration of survival from treatment to death was known in 96+% of cases. Survival was 9 months longer after 64 resections for stage I-II (localized) pancreatic cancer than after 149 other treatments (P < 0.05, ANOVA), but resection did not increase mean survival in 49 patients with stage III (lymph node metastases) disease. Twenty-one patients with ampullary, duodenal, bile duct, or cystic cancers had a significantly increased survival at any stage, but this may be due to the selection of sicker patients for nonoperative therapies.