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Objective: To evaluate whether quality measures have improved overall survival for pancreatic adenocarcinoma after surgical resection over two decades.
Design, Setting, Patients: Data from the National Cancer Institute’s Surveillance, Epidemiology and End Results program (1988-2008) were used to identity 12,772 patients who underwent surgical resection for adenocarcinoma of the pancreas. Patients were stratified according to number of lymph nodes (LNs) examined over time.
Main Outcome Measures: Examination of LNs over time (year stratums (YS) 1988-1993, 1994-1998, 1999-2003 and 2003-2008) and correlation with overall survival (OS).
Results: Patients with at least 15 LNs (n=2867) have increased over time (by YS: 10%, 14%, 17% & 33%, p < 0.0001). While the LN positivity rate has increased so has OS (Table 1, p < 0.0001). Median OS per LN stratum (1-9, 10-14 or >15) for localized (Stage I), regional (Stage II & III) and distant (Stage IV) disease increased over time: local (32, 33 and 54 months); regional (14, 16 & 18 months) and distant (9, 11 and 12 months).
Conclusions: In the largest study evaluating pancreatic resection for pancreas cancer, significant improvements in surgical quality measures have occurred over the past two decades. This may be contributing to a dramatic improvement in overall survival.

Node Positivity Rate and Overall Survival (*only includes pts with ≥1 LN examined)

Year Stratum (YS)	N = 12,772	% with ≥15 LN Examined		% node positive*	1-yr OS	3-yr OS	5-yr OS
1988-1993	1318	131 (10%)		55%	42.9%	16.4%	12.4%
1994-1998	1799	242 (14%)		56%	51.8%	19.9%	13.8%
1999-2003	4419	770 (17%)		58%	55.0%	22.0%	15.5%
2004-2008	5236	1724 (33%)		62%	68.7%	30.4%	22.0%