Urban versus rural residency and pancreatic cancer survival: A Danish nationwide population-based cohort study.

It is unknown whether urban versus rural residency affects pancreatic cancer survival in a universal tax-financed healthcare system. We conducted a nationwide, population-based cohort study of all patients diagnosed with pancreatic cancer in Denmark from 2004-2015. We used nationwide registries to collect information on characteristics, comorbidity, cancer-directed treatment, and vital status. We followed the patients from pancreatic cancer diagnosis until death, emigration, or 1 October 2017, whichever occurred first. We truncated at five years of follow up. We stratified patients into calendar periods according to year of diagnosis (2004-2007, 2008-2011, and 2012-2015). We used Cox proportional hazards model to compute hazard ratios (HRs) with associated 95% confidence intervals (CIs) of death, comparing patients in urban and rural areas. HRs were adjusted for age, sex, comorbidity, tumor stage, and localization. In a sub-analysis, we also adjusted for cancer-directed treatment. We included 10,594 patients diagnosed with pancreatic cancer. Median age was 71 years (inter-quartile range: 63-78 years), and half were men. The majority (61.7%) lived in an urban area at the time of diagnosis. When adjusting for potential confounders, we observed a better survival rate among pancreatic cancer patients residing in urban areas compared with rural areas (adjusted HR: 0.92; 95% CI: 0.87-0.98). When taking treatment into account, the association was unclear (adjusted HR: 0.96; 95% CI: 0.88-1.04). Pancreatic cancer patients residing in urban areas had a slightly better survival rate compared with patients in rural areas

Longterm outcome after early repair of iatrogenic bile duct injury. A national Danish multicentre study

AbstractBackgroundThe aim of this retrospective study was to evaluate the perioperative and longterm outcome after early repair with a hepaticojejunostomy (HJ).MethodsBetween 1995 and 2010, a nationwide, retrospective multicentre study was conducted. All iatrogenic bile duct injury (BDI) sustained during a cholecystectomy and repaired with HJ in the five HepatoPancreaticoBiliary centres in Denmark were included.ResultsIn total, 139 patients had an HJ repair. The median time from the BDI to reconstruction was 5 days. A concomitant vascular injury was identified in 26 cases (19%). Postoperative morbidity was 36% and mortality was 4%. Fortytwo patients (30%) had a stricture of the HJ. The median followup time without stricture was 102 months. Nineteen out of the 42 patients with postreconstruction biliary strictures had a reHJ. Twentythree patients were managed with percutaneous transhepatic cholangiography and dilation. The overall success rate of reestablishing the biliodigestive flow approached 93%. No association was found between timing of repair, concomitant vascular injury, level of injury and stricture formation.ConclusionIn this national, unselected and consecutive cohort of patients with BDI repaired by early HJ we found a considerable risk of longterm complications (e.g. 30% stricture rate) and mortality in both the short and the longterm perspective