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Background: Acinar cell carcinoma (ACC) is a rare cancer of the pancreas accounting for approximately 1% of nonendocrine tumors. Because no large series of patients with ACC exist, our understanding of this disease comes mainly from small retrospective reports and anecdotal experience. Objective: Our goal was to evaluate a large population-based cohort of patients with ACC and compare their demographic factors and outcomes to those of patients with pancreatic adenocarcinoma (PA). Methods: Using the Surveillance, Epidemiology, and End Results (SEER) database (1988 to 2003), we identified all patients with ACC or PA. The demographic factors, tumor characteristics, resection status, and long-term survival were compared between the 2 groups. Results: A total of 672 patients with ACC and 58,526 with PA were identified. The mean age at the time of diagnosis was significantly lower for ACC than PA (56 years vs 70 years, P < .001). Compared with patients with PA, patients with ACC were more likely to be male (54% vs 48%, P = .007) and white (85% vs 81%, P = .03). Based on SEER clinical staging, patients with ACC were less likely to have unstaged disease (8% vs 18%). Of the 616 patients with staged ACC, 16% had localized disease, 26% had regional disease, and 58% had distant disease. In the 47,896 staged patients with PA, 10% had localized disease, 33% had regional disease, and 57% had distant disease (P < .0001 compared to ACC). Based on clinical extent of disease, 81% of patients with locoregional ACC and 70% of patients with locoregional PA were resectable. However, only 69% of ACC patients with locoregional disease and 27% of PA patients with locoregional disease underwent surgical resection. The overall 5-year survival was 42.8% for ACC (median, 47 months) and 3.8% for PA (median, 4 months, P < .0001). Patients with unresected ACC had a 5-year survival rate of 22% compared to 2% in patients with unresected PA (P < .0001). Surgical resection significantly improved survival. The 5-year survival was 72% in resected ACC and 16.3% in resected PA (P < .0001). Multivariate Cox proportional hazards regression model results suggested patients with ACC were less likely to die (hazard ratio = 0.241; 95% confidence interval, 0.22-0.27) than patients with PA after controlling for gender, race, stage, SEER region of diagnosis, and surgical resection status. Conclusions: Consistent with anecdotal reports and previous retrospective studies, ACC is a more indolent disease than PA. Patients with ACC tend to present at a younger age, are more likely to have resectable disease, and are much more likely to undergo potentially curative resection. The long-term survival for patients with ACC is significantly better when compared to the long-term survival of patients with PA. [Copyright &y& Elsevier]

Background: A strong volume-outcome relationship has been demonstrated for pancreatic resection, and regionalization of care to high-volume centers (>11 resections/year) has been recommended. However, it is unclear if volume alone should be the sole criteria for regionalization. The objective of this study is to evaluate variability in outcomes among high-volume hospitals (>11 resections/year). Methods: We used the Texas Hospital Inpatient Discharge Database from 1999 through 2005 to evaluate variability in outcomes after pancreatic resection among high-volume hospitals in Texas. The outcome variables of interest were mortality, length of stay, discharge to a skilled nursing facility, operation within 24 hours of hospital admission, and total hospital charges. Unadjusted and adjusted models were performed. Results: A total of 12 high-volume hospitals were in Texas. The number of resections at each hospital ranged from 78–608 cases for the 7-year time period studied. In unadjusted models, there was significant variability in mortality (range, 0.7%–7.7%, P < .0001), duration of stay (range of medians, 9–21 days, P < .0001), the need for ongoing nursing care at discharge (range, 0.7%–41.4%, P < .0001), operation within 24 hours of admission (range, 41%–96%, P < .0001), and total hospital charges (median range, $38,318–$110,860, P < .0001). There were significant differences in the demographics, risks of mortality, and illness severity among the 12 high-volume hospitals. Therefore, multivariate models were used to control for age group, sex, race/ethnicity, risk of mortality, illness severity, admission status, diagnosis, procedure, and insurance status. In the multivariate models, the particular hospital at which the pancreatic surgery was performed was a significant independent predictor of every outcome variable except mortality. Conclusions: For pancreatic resection, there is significant variability in outcomes even among high-volume providers. Individual hospitals likely account for much of the variability not explained by hospital volume. Although the structure measure of hospital volume is easy to measure, these data suggest that it is not a reliable single measure of quality or outcomes after pancreatic surgery. [Copyright &y& Elsevier]

Background: The current recommendation is that pancreatic resections be performed at hospitals doing >10 pancreatic resections annually.Objective: To evaluate the extent of regionalization of pancreatic resection and the factors predicting resection at high-volume centers (>10 cases/year) in Texas.Methods: Using the Texas Hospital Inpatient Discharge Public Use Data File, we evaluated trends in the percentage of patients undergoing pancreatic resection at high-volume centers (>10 cases/year) from 1999 to 2004 and determined the factors that independently predicted resection at high-volume centers.Results: A total of 3,189 pancreatic resections were performed in the state of Texas. The unadjusted in-hospital mortality was higher at low-volume centers (7.4%) compared to high-volume centers (3.0%). Patients resected at high-volume centers increased from 54.5% in 1999 to 63.3% in 2004 (P = 0.0004). This was the result of a decrease in resections performed at centers doing less than five resections/year (35.5% to 26.0%). In a multivariate analysis, patients who were >75 (OR = 0.51), female (OR = 0.86), Hispanic (OR = 0.58), having emergent surgery (OR = 0.39), diagnosed with periampullary cancer (OR = 0.68), and living >75 mi from a high-volume center (OR = 0.93 per 10-mi increase in distance, P < 0.05 for all OR) were less likely to be resected at high-volume centers. The odds of being resected at a high-volume center increased 6% per year.Conclusions: Whereas regionalization of pancreatic resection at high-volume centers in the state of Texas has improved slightly over time, 37% of patients continue to undergo pancreatic resection at low-volume centers, with more than 25% occurring at centers doing less than five per year. There are obvious demographic disparities in the regionalization of care, but additional unmeasured barriers need to be identified. [ABSTRACT FROM AUTHOR]

Background: It is unknown whether the improved survival seen at high-volume centers has been translated to all patients with pancreatic cancer.Objective: To use the Surveillance, Epidemiology, and End Results (SEER) database to evaluate population-based trends in surgical resection and survival.Methods: All patients diagnosed with pancreatic cancer from 1988-1999 were identified. The survival and proportion of patients undergoing surgical resection were compared for each of three equal time periods.Results: There were 24,016 patients with pancreatic cancer. 19,533 had stage data available. 9% had localized, 29% had regional, and 62% had distant disease. Resection rates increased for patients with localized and regional disease over the three time periods. Survival increased for patients with regional and distant disease. For regional pancreatic cancer patients, 2-year survival increased from 9.5% to 13.5% (p < 0.0001) and from 21.5% to 28.9% following surgical resection (p = 0.002). For resected local/regional pancreatic cancer, the year of diagnosis was and independent predictor of improved survival (p = 0.0001).Conclusions: SEER patients with regional and distant pancreatic cancer have improved survival over the past decade in both unadjusted and adjusted models. The improvement is most striking for patients with regional disease and reflects increased resection rates and improved resection techniques over time. [ABSTRACT FROM AUTHOR]