title: Underuse of surgical resection among elderly patients with early-stage pancreatic cancer.
abstract: BACKGROUND
  Although surgery improves the health care quality and outcomes of patients with early-stage pancreatic cancer, these patients' operative resection rate has been historically low. We sought to identify factors that are associated with operative resection in this patient population.
  
  
  METHODS
  In this retrospective population-based study, we used Texas Cancer Registry-linked and Surveillance and Epidemiology End Results Program-linked Medicare data to study factors potentially associated with operative resection in patients age ≥ 66 years who had been diagnosed with localized pancreatic cancer between January 1, 2001, and December 31, 2009. Variables were assessed using multivariate logistic regression and Cox proportional hazards regression models. We used Kaplan-Meier analysis to assess the effect of operative resection on survival rate.
  
  
  RESULTS
  Of 1,501 patients with localized pancreatic cancer, only 340 (22.7%) underwent operation. Patients were more likely to undergo surgery if they were young, had small tumors, had low-grade tumors, and had nodal negativity (P < .05). Compared with patients who did not undergo surgery, patients who underwent surgery had a significantly higher 5-year overall survival rate (25.0 vs 2.3%; P < .0001) and had a higher median survival time (24.3 vs 5.8 months).
  
  
  CONCLUSIONS
  The rate of operative resection of early-stage pancreatic cancer did not increase significantly from 2001 to 2009. Although we identified several variables associated with operative resection, why the percentage of patients with localized pancreatic cancer who undergo definitive surgery is so low remains unclear.
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Weiguo
authors.initials: W
authors.lastname: He
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX. Electronic address: huizhao@mdanderson.org.
authors.forename: Hui
authors.initials: H
authors.lastname: Zhao
authors.affiliation: Division of Biostatistics, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: Wenyaw
authors.initials: W
authors.lastname: Chan
authors.affiliation: Department of Epidemiology, School of Public Health, the University of Texas Health Science Center at Houston, Houston, TX.
authors.forename: David
authors.initials: D
authors.lastname: Lopez
authors.affiliation: Department of Gastrointestinal Medical Oncology, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Rachna T
authors.initials: RT
authors.lastname: Shroff
authors.affiliation: Department of Health Services Research, The University of Texas MD Anderson Cancer Center, Houston, TX.
authors.forename: Sharon H
authors.initials: SH
authors.lastname: Giordano
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D000367:Age Factors; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008297:Male; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D018579:Patient Selection; D016016:Proportional Hazards Models; D012189:Retrospective Studies; D018426:SEER Program; D015996:Survival Rate; D013781:Texas