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Variations in Surgical Treatment and Outcomes of Patients With Pancreatic Cancer: A Population-Based Study

  • Hepatobiliary and Pancreatic Tumors
  • Original Paper
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

There is ongoing debate on how variations in surgical technique affect outcomes in pancreatic cancer. This population-based study examines current surgical practice and outcomes for cancer of the pancreatic head.

Methods

All patients 18 to 85 years old diagnosed with nonmetastatic adenocarcinoma of the pancreatic head from 1998 through 2003 were identified from the Surveillance, Epidemiology and End Results (SEER) Program registry. Multivariable regression was used to elucidate factors associated with the type of pancreaticoduodenectomy performed, extent of lymph node (LN) assessment, early mortality, and late survival.

Results

Overall, 2111 patients were included in the study, with 83.7% treated with a standard Whipple pancreaticoduodenectomy (PD). However, there was marked regional variation in the use of pylorus-preserving pancreaticoduodenectomy (PPPD; range, .03%–32.0%; P < .0001) and total pancreatectomy (TP; range, .04%–19.5%; P < .0001). TP was associated with significantly higher early mortality (odds ratio, 2.6; 95% confidence interval, 1.6 to 4.1; P < .0001), but late survival did not differ significantly between TP, PPPD, and PD (P = .69). Significant variation was also seen in the number of LN assessed (range across SEER regions, 7.3–13.5; P < .0001). Decreased LN assessment reduced the odds of diagnosing a patient as node positive and was associated with worse late survival.

Conclusions

In this population-based study, we found marked clinically important variability in the surgical treatment of adenocarcinoma of the pancreatic head, with respect to the use of TP, PPPD, or PD, and the extent of LN assessment. Further research is warranted to elucidate the underlying reasons, and to clarify the role of adequate lymphadenectomy.

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Acknowledgments

A.G. is supported by the National Cancer Institute of Canada/Canadian Cancer Society Clinical Research Fellowship. N.N.B. is supported by an American Society of Clinical Oncology Career Development Award. C.H.L.L. is a career scientist of the Ontario Ministry of Health and Long-Term Care and is supported through a Health Research Personnel Development—Career Scientist Award.

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Authors and Affiliations

  1. Division of General Surgery, University of Toronto, Toronto, Canada

    Anand Govindarajan MD, MSc, Jensen C. C. Tan MD, Nancy N. Baxter MD, PhD, Natalie G. Coburn MD, MPH & Calvin H. L. Law MD, MPH

  2. St. Michael’s Hospital, University of Toronto, Toronto, Canada

    Nancy N. Baxter MD, PhD

  3. Department of Health Policy, Management and Evaluation, University of Toronto, Toronto, Canada

    Natalie G. Coburn MD, MPH & Calvin H. L. Law MD, MPH

  4. Institute for Clinical Evaluative Sciences, University of Toronto, Toronto, Canada

    Natalie G. Coburn MD, MPH & Calvin H. L. Law MD, MPH

  5. Division of Surgical Oncology, Toronto-Sunnybrook Regional Cancer Centre, University of Toronto, Toronto, Canada

    Natalie G. Coburn MD, MPH & Calvin H. L. Law MD, MPH

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  1. Anand Govindarajan MD, MSc
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  2. Jensen C. C. Tan MD
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  3. Nancy N. Baxter MD, PhD
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  5. Calvin H. L. Law MD, MPH
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Correspondence to Calvin H. L. Law MD, MPH.

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Govindarajan, A., Tan, J.C.C., Baxter, N.N. et al. Variations in Surgical Treatment and Outcomes of Patients With Pancreatic Cancer: A Population-Based Study. Ann Surg Oncol 15, 175–185 (2008). https://doi.org/10.1245/s10434-007-9601-7

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  • DOI: https://doi.org/10.1245/s10434-007-9601-7

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