title: Is it worth looking? Abdominal imaging after pancreatic cancer resection: a national study.
abstract: BACKGROUND
  Abdominal imaging is often performed after pancreatic cancer resection. We attempted to quantify the volume and estimate the cost of complex imaging after pancreatectomy nationwide, and to determine whether their frequent use confers benefit.
  
  
  METHODS
  Patients with pancreatic adenocarcinoma who underwent resection were identified in Surveillance, Epidemiology and End Results-Medicare (1991-2005). Claims for abdominal imaging ≤5 years after resection were analyzed. Patients receiving annual CT scans were identified. Univariate and multivariate analyses were performed. To assess frequency of annual CT scanning in patients with superior survival, the top decile was further analyzed.
  
  
  RESULTS
  Eleven thousand eight hundred fifty studies were performed on 2,217 patients. Ten thousand five hundred forty-two (89%) were CT scans. The median number of scans doubled from three in 1991 to six in 2005 (p < 0.0001). Among patients with sufficient survival to allow for analysis, 51.3% received annual CT scans, while only 32.4% of top-performing patients received annual scans. Univariate analysis of the 10% of patients with superior survival did not reveal any significant benefit associated with annual imaging.
  
  
  CONCLUSIONS
  Utilization of complex imaging after pancreatic cancer resection has increased substantially among Medicare beneficiaries, driven primarily by an increasing number of CT scans. Our study demonstrated no significant survival benefit among patients who received scans on a routine basis.
authors.affiliation: Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, 55 Lake Avenue North, S3-752, Worcester, MA 01655-0002, USA.
authors.forename: Elan R
authors.initials: ER
authors.lastname: Witkowski
authors.forename: Jillian K
authors.initials: JK
authors.lastname: Smith
authors.forename: Elizaveta
authors.initials: E
authors.lastname: Ragulin-Coyne
authors.forename: Sing-Chau
authors.initials: SC
authors.lastname: Ng
authors.forename: Shimul A
authors.initials: SA
authors.lastname: Shah
authors.forename: Jennifer F
authors.initials: JF
authors.lastname: Tseng
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000368:Aged; D015331:Cohort Studies; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D016015:Logistic Models; D008279:Magnetic Resonance Imaging / Q000191:economics* / Q000706:statistics & numerical data; D008297:Male; D006278:Medicare / Q000706:statistics & numerical data; D015999:Multivariate Analysis; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000601:surgery*; D049268:Positron-Emission Tomography / Q000191:economics* / Q000706:statistics & numerical data; D011860:Radiography, Abdominal / Q000191:economics* / Q000706:statistics & numerical data; D018426:SEER Program / Q000706:statistics & numerical data; D014057:Tomography, X-Ray Computed / Q000191:economics* / Q000706:statistics & numerical data; D014481:United States