Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma

Daniel P. Nussbaum, Mohamed A. Adam, Linda M. Youngwirth, Asvin M. Ganapathi, Sanziana A. Roman, Douglas Tyler, Julie A. Sosa, Dan G. Blazer

    Research output: Contribution to journalArticle

    22 Citations (Scopus)

    Abstract

    Background: The modifiable variable best proven to improve survival after resection of pancreatic adenocarcinoma is the addition of adjuvant chemotherapy. A theoretical advantage of minimally invasive pancreaticoduodenectomy (MI-PD) is the potential for greater use and earlier initiation of adjuvant therapy, but this benefit remains unproven. Methods: The 2010–2012 National Cancer Data Base (NCDB) was queried for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Subjects were classified as MI-PD versus open pancreaticoduodenectomy (O-PD). Baseline variables were compared between groups. The independent effect of surgical approach on the use and timing of adjuvant chemotherapy was estimated using multivariable regression analyses. Results: For this study, 7967 subjects were identified: 1191 MI-PD (14.9 %) and 6776 O-PD (85.1 %) patients. Patients who underwent MI-PD were more likely to have been treated at academic hospitals. Otherwise, the groups had no baseline differences. In both the MI-PD and O-PD groups, approximately 50 % of the patients received adjuvant chemotherapy, initiated at a median of 54 versus 55 days postoperatively (p = 0.08). After multivariable adjustment, surgical approach was not independently associated with use (odds ratio 1.00; p = 0.99) or time to initiation of adjuvant chemotherapy (–2.3 days; p = 0.07). Younger age, insured status, lower comorbidity score, higher tumor stage, and the presence of lymph node metastases were independently associated with the use of adjuvant chemotherapy. Conclusions: At a national level, MI-PD does not result in greater use or earlier initiation of adjuvant chemotherapy. As surgeons and institutions continue to gain experience with this complex procedure, it will be important to revisit this benchmark as a justification for its increasing use for patients with pancreatic cancer.

    Original languageEnglish (US)
    Pages (from-to)1026-1033
    Number of pages8
    JournalAnnals of Surgical Oncology
    Volume23
    Issue number3
    DOIs
    StatePublished - Mar 1 2016

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    Pancreaticoduodenectomy
    Adjuvant Chemotherapy
    Adenocarcinoma
    Benchmarking
    Pancreatic Neoplasms
    Comorbidity
    Neoplasms
    Lymph Nodes
    Odds Ratio
    Regression Analysis
    Databases
    Neoplasm Metastasis

    ASJC Scopus subject areas

    • Surgery
    • Oncology

    Cite this

    Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma. / Nussbaum, Daniel P.; Adam, Mohamed A.; Youngwirth, Linda M.; Ganapathi, Asvin M.; Roman, Sanziana A.; Tyler, Douglas; Sosa, Julie A.; Blazer, Dan G.

    In: Annals of Surgical Oncology, Vol. 23, No. 3, 01.03.2016, p. 1026-1033.

    Research output: Contribution to journalArticle

    Nussbaum, Daniel P. ; Adam, Mohamed A. ; Youngwirth, Linda M. ; Ganapathi, Asvin M. ; Roman, Sanziana A. ; Tyler, Douglas ; Sosa, Julie A. ; Blazer, Dan G. / Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma. In: Annals of Surgical Oncology. 2016 ; Vol. 23, No. 3. pp. 1026-1033.
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    title = "Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma",
    abstract = "Background: The modifiable variable best proven to improve survival after resection of pancreatic adenocarcinoma is the addition of adjuvant chemotherapy. A theoretical advantage of minimally invasive pancreaticoduodenectomy (MI-PD) is the potential for greater use and earlier initiation of adjuvant therapy, but this benefit remains unproven. Methods: The 2010–2012 National Cancer Data Base (NCDB) was queried for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Subjects were classified as MI-PD versus open pancreaticoduodenectomy (O-PD). Baseline variables were compared between groups. The independent effect of surgical approach on the use and timing of adjuvant chemotherapy was estimated using multivariable regression analyses. Results: For this study, 7967 subjects were identified: 1191 MI-PD (14.9 {\%}) and 6776 O-PD (85.1 {\%}) patients. Patients who underwent MI-PD were more likely to have been treated at academic hospitals. Otherwise, the groups had no baseline differences. In both the MI-PD and O-PD groups, approximately 50 {\%} of the patients received adjuvant chemotherapy, initiated at a median of 54 versus 55 days postoperatively (p = 0.08). After multivariable adjustment, surgical approach was not independently associated with use (odds ratio 1.00; p = 0.99) or time to initiation of adjuvant chemotherapy (–2.3 days; p = 0.07). Younger age, insured status, lower comorbidity score, higher tumor stage, and the presence of lymph node metastases were independently associated with the use of adjuvant chemotherapy. Conclusions: At a national level, MI-PD does not result in greater use or earlier initiation of adjuvant chemotherapy. As surgeons and institutions continue to gain experience with this complex procedure, it will be important to revisit this benchmark as a justification for its increasing use for patients with pancreatic cancer.",
    author = "Nussbaum, {Daniel P.} and Adam, {Mohamed A.} and Youngwirth, {Linda M.} and Ganapathi, {Asvin M.} and Roman, {Sanziana A.} and Douglas Tyler and Sosa, {Julie A.} and Blazer, {Dan G.}",
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    T1 - Minimally Invasive Pancreaticoduodenectomy Does Not Improve Use or Time to Initiation of Adjuvant Chemotherapy for Patients With Pancreatic Adenocarcinoma

    AU - Nussbaum, Daniel P.

    AU - Adam, Mohamed A.

    AU - Youngwirth, Linda M.

    AU - Ganapathi, Asvin M.

    AU - Roman, Sanziana A.

    AU - Tyler, Douglas

    AU - Sosa, Julie A.

    AU - Blazer, Dan G.

    PY - 2016/3/1

    Y1 - 2016/3/1

    N2 - Background: The modifiable variable best proven to improve survival after resection of pancreatic adenocarcinoma is the addition of adjuvant chemotherapy. A theoretical advantage of minimally invasive pancreaticoduodenectomy (MI-PD) is the potential for greater use and earlier initiation of adjuvant therapy, but this benefit remains unproven. Methods: The 2010–2012 National Cancer Data Base (NCDB) was queried for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Subjects were classified as MI-PD versus open pancreaticoduodenectomy (O-PD). Baseline variables were compared between groups. The independent effect of surgical approach on the use and timing of adjuvant chemotherapy was estimated using multivariable regression analyses. Results: For this study, 7967 subjects were identified: 1191 MI-PD (14.9 %) and 6776 O-PD (85.1 %) patients. Patients who underwent MI-PD were more likely to have been treated at academic hospitals. Otherwise, the groups had no baseline differences. In both the MI-PD and O-PD groups, approximately 50 % of the patients received adjuvant chemotherapy, initiated at a median of 54 versus 55 days postoperatively (p = 0.08). After multivariable adjustment, surgical approach was not independently associated with use (odds ratio 1.00; p = 0.99) or time to initiation of adjuvant chemotherapy (–2.3 days; p = 0.07). Younger age, insured status, lower comorbidity score, higher tumor stage, and the presence of lymph node metastases were independently associated with the use of adjuvant chemotherapy. Conclusions: At a national level, MI-PD does not result in greater use or earlier initiation of adjuvant chemotherapy. As surgeons and institutions continue to gain experience with this complex procedure, it will be important to revisit this benchmark as a justification for its increasing use for patients with pancreatic cancer.

    AB - Background: The modifiable variable best proven to improve survival after resection of pancreatic adenocarcinoma is the addition of adjuvant chemotherapy. A theoretical advantage of minimally invasive pancreaticoduodenectomy (MI-PD) is the potential for greater use and earlier initiation of adjuvant therapy, but this benefit remains unproven. Methods: The 2010–2012 National Cancer Data Base (NCDB) was queried for patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma. Subjects were classified as MI-PD versus open pancreaticoduodenectomy (O-PD). Baseline variables were compared between groups. The independent effect of surgical approach on the use and timing of adjuvant chemotherapy was estimated using multivariable regression analyses. Results: For this study, 7967 subjects were identified: 1191 MI-PD (14.9 %) and 6776 O-PD (85.1 %) patients. Patients who underwent MI-PD were more likely to have been treated at academic hospitals. Otherwise, the groups had no baseline differences. In both the MI-PD and O-PD groups, approximately 50 % of the patients received adjuvant chemotherapy, initiated at a median of 54 versus 55 days postoperatively (p = 0.08). After multivariable adjustment, surgical approach was not independently associated with use (odds ratio 1.00; p = 0.99) or time to initiation of adjuvant chemotherapy (–2.3 days; p = 0.07). Younger age, insured status, lower comorbidity score, higher tumor stage, and the presence of lymph node metastases were independently associated with the use of adjuvant chemotherapy. Conclusions: At a national level, MI-PD does not result in greater use or earlier initiation of adjuvant chemotherapy. As surgeons and institutions continue to gain experience with this complex procedure, it will be important to revisit this benchmark as a justification for its increasing use for patients with pancreatic cancer.

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    U2 - 10.1245/s10434-015-4937-x

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    EP - 1033

    JO - Annals of Surgical Oncology

    JF - Annals of Surgical Oncology

    SN - 1068-9265

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