Factors involved in health-related transitions after curative resection for pancreatic cancer. 10-Years experience: A multi state model

Background: Pancreatic cancer is one of the least common tumours, nevertheless it is one of the most lethal. This lethality is mainly due to the fact that the vast majority of patients are diagnosed in an advanced stage. The purpose of this study was to investigate how different covariates affect the transition to death or discharge with and without complications after pancreatic resection. Methods: We analyse the impact of different factors on transitions after pancreatic resection based on a multi state model. Results: Transitions of interest include the transition to death/discharge with/without complications after pancreatic resection. We consider presence of comorbidities, higher age (>60), gender-male, lower hospital volume (<10 cases per year), type of surgery, localization of tumour and transfusion received as covariates with a potentially negative effect on the transition intensities to death with or without complications. Conclusions: The multi-state model allows for a very detailed analysis of the impact of covariates on each transition, since effects of covariates may change depending on the current state of the patient, thus helping surgeons and patients throughout the surgical process and counselling patients if needed. (C) 2012 Elsevier Ltd. All rights reserved.