Type of Resection (Whipple vs. Distal) Does Not Affect the National Failure to Provide Post-resection Adjuvant Chemotherapy in Localized Pancreatic Cancer
- 269 Downloads
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).
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.
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).
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.
KeywordsOverall Survival Pancreatic Cancer Adjuvant Chemotherapy Adjuvant Therapy National Cancer Data Base
The NCDB is a joint project of the CoC of the American College of Surgeons and the American Cancer Society. The data used are derived from a de-identified NCDB PUF. The American College of Surgeons and the CoC have not verified and are not responsible for the analytic or statistical methods or the conclusions drawn from these data by the investigators. The authors gratefully acknowledge the support of the Mayo Clinic Department of Surgery and the Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery as substantial contributors of resources to the project. Additionally, Dr. Bergquist acknowledges the support of the Mayo Clinic Clinician Investigator Training Program for salary support. Finally, we would like to thank the Society for Surgery of the Alimentary Tract for affording us the opportunity to present this work at their annual Digestive Disease Week in San Diego, CA, USA, in May 2016.
The Mayo Clinic Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery provides salary support for Dr. Habermann and in kind material support for Drs. Bergquist and Shubert. In addition, Drs. Bergquist and Shubert have received salary support from the Mayo Clinic Clinician Investigator Training program.
- 4.Yeo CJ, Abrams RA, Grochow LB, Sohn TA, Ord SE, Hruban RH, et al. Pancreaticoduodenectomy for pancreatic adenocarcinoma: postoperative adjuvant chemoradiation improves survival. A prospective, single-institution experience. Ann Surg. 1997;225(5):621-633, discussion 633–636.Google Scholar
- 5.Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer. 2009;101(6):908–15.CrossRefPubMedPubMedCentralGoogle Scholar
- 6.Wang H, Ramakrishnan A, Fletcher S, Prochownik EV, Genetics M. Early vs. late chemoradiation therapy and the postoperative interval to adjuvant therapy do not correspond to local recurrence in resected pancreatic cancer. Pancreat Discord Ther. 2015;5(2): pii: 151.Google Scholar