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Annals of Surgical Oncology
Published in: Annals of Surgical Oncology 6/2017

01-06-2017 | Pancreatic Tumors

Type of Resection (Whipple vs. Distal) Does Not Affect the National Failure to Provide Post-resection Adjuvant Chemotherapy in Localized Pancreatic Cancer

Authors: John R. Bergquist, MS, MD, Tommy Ivanics, MD, Christopher R. Shubert, MHA, MD, Elizabeth B. Habermann, PhD, Rory L. Smoot, MD, Michael L. Kendrick, MD, David M. Nagorney, MD, FACS, Michael B. Farnell, MD, FACS, Mark J. Truty, MS, MD

Published in: Annals of Surgical Oncology | Issue 6/2017

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Abstract

Introduction

Adjuvant chemotherapy improves survival after curative intent resection for localized pancreatic adenocarcinoma (PDAC). Given the differences in perioperative morbidity, we hypothesized that patients undergoing distal partial pancreatectomy (DPP) would receive adjuvant therapy more often those undergoing pancreatoduodenectomy (PD).

Methods

The National Cancer Data Base (2004–2012) identified patients with localized PDAC undergoing DPP and PD, excluding neoadjuvant cases, and factors associated with receipt of adjuvant therapy were identified. Overall survival (OS) was analyzed using multivariable Cox proportional hazards regression.

Results

Overall, 13,501 patients were included (DPP, n = 1933; PD, n = 11,568). Prognostic characteristics were similar, except DPP patients had fewer N1 lesions, less often positive margins, more minimally invasive resections, and shorter hospital stay. The proportion of patients not receiving adjuvant chemotherapy was equivalent (DPP 33.7%, PD 32.0%; p = 0.148). The type of procedure was not independently associated with adjuvant chemotherapy (hazard ratio 0.96, 95% confidence interval 0.90–1.02; p = 0.150), and patients receiving adjuvant chemotherapy had improved unadjusted and adjusted OS compared with surgery alone. The type of resection did not predict adjusted mortality (p = 0.870).

Conclusion

Receipt of adjuvant chemotherapy did not vary by type of resection but improved survival independent of procedure performed. Factors other than type of resection appear to be driving the nationwide rates of post-resection adjuvant chemotherapy in localized PDAC.
Appendix
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Metadata
Title
Type of Resection (Whipple vs. Distal) Does Not Affect the National Failure to Provide Post-resection Adjuvant Chemotherapy in Localized Pancreatic Cancer
Authors
John R. Bergquist, MS, MD
Tommy Ivanics, MD
Christopher R. Shubert, MHA, MD
Elizabeth B. Habermann, PhD
Rory L. Smoot, MD
Michael L. Kendrick, MD
David M. Nagorney, MD, FACS
Michael B. Farnell, MD, FACS
Mark J. Truty, MS, MD
Publication date
01-06-2017
Publisher
Springer International Publishing
Published in
Annals of Surgical Oncology / Issue 6/2017
Print ISSN: 1068-9265
Electronic ISSN: 1534-4681
DOI
https://doi.org/10.1245/s10434-016-5762-6

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