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 22 November 2017

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News

Failure to operate on early stage pancreatic cancer in the USA

The most recent issue of Annals of Surgery reports that pancreatectomy in the United States is underused.

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Despite studies demonstrating improved outcomes, pessimism persists regarding the effectiveness of surgery for pancreatic cancer.

Dr Karl Bilimoria and colleagues evaluated utilization of surgery in early stage disease and identified factors predicting failure to undergo surgery.

The team used the National Cancer Data Base between 1995 and 2004, 9559 patients were identified with potentially resectable tumors.

Multivariate models were employed to identify factors predicting failure to undergo surgery, and to assess the impact of pancreatectomy on survival.

The team noticed that 71% of clinical Stage I patients did not undergo surgery.

The research team reported that 6% were excluded due to co morbidities, and 4% refused surgery.

38% failed to undergo surgery
Annals of Surgery

About 9% were excluded due to age, and 38% with potentially resectable cancers were classified as ‘not offered surgery‘.

The team found that of the 29% patients who underwent surgery, 96% underwent pancreatectomy, and 4% had unresectable tumors.

The team observed that patients were less likely to undergo surgery if they were older than 65 years, were black, or were on Medicare or Medicaid.

In addition, patients less likely to undergo surgery had pancreatic head lesions, earned lower annual incomes, or had less education.

The research team noted that patients were less likely to receive surgery at low-volume and community centers.

Patients underwent surgery more frequently at National Cancer Institute/National Comprehensive Cancer Network-designated cancer centers.

Patients who were not offered surgery had better survival than those with Stage III or IV disease.

However, the team noted that patients who were not offered surgery had worse survival than patients who underwent pancreatectomy for Stage I disease.

Dr Bilimoria's team concluded, "This is the first study to characterize the striking underuse of pancreatectomy in the United States."

"Of early stage pancreatic cancer patients without any identifiable contraindications, 38% failed to undergo surgery."

Ann Surg 2007: 246(2): 173-80
21 August 2007

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