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.
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA. daniel.nussbaum@duke.edu.
authors.forename: Daniel P
authors.initials: DP
authors.lastname: Nussbaum
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Linda M
authors.initials: LM
authors.lastname: Youngwirth
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Asvin M
authors.initials: AM
authors.lastname: Ganapathi
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.affiliation: Department of Surgery, The University of Texas Medical Branch, Galveston, TX, USA.
authors.forename: Douglas S
authors.initials: DS
authors.lastname: Tyler
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
authors.affiliation: Department of Surgery, Duke University, Durham, NC, USA.
authors.forename: Dan G
authors.initials: DG
authors.lastname: Blazer
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000556:secondary / Q000601:surgery*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use*; D017024:Chemotherapy, Adjuvant; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008207:Lymphatic Metastasis; D008297:Male; D019060:Minimally Invasive Surgical Procedures / Q000706:statistics & numerical data*; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate; D061665:Time-to-Treatment