title: National disparities in minimally invasive surgery for pancreatic tumors.
abstract: For patients with pancreatic tumors, several disparities have been shown to impact access to care, including surgery, and subsequently adversely affect long-term oncologic outcomes. The aim of this study was to investigate national disparities in minimally invasive surgery (MIS) across different demographics for pancreatic tumors.
  
  
  
  We utilized the American College of Surgeons (ACS) National Cancer Data Base (NCDB) to identify patients with pancreatic tumors from 2010 to 2011 who had undergone surgery through either an open or MIS approach. Multivariable analysis was performed to investigate differences in patient characteristics in relation to surgical approach and conversion to open.
  
  
  
  A total of 2809 patients were identified. The initial surgical approach included 86.5 % open (2430) and 13.5 % MIS (87.6 % were laparoscopic, and 12.4 % were robotic). Tumor histology was significantly associated with MIS, whereby patients with neuroendocrine tumors were more than twice as likely to have an MIS approach compared to adenocarcinoma. Tumor location within the pancreas was also associated with MIS, with tumors in the tail being three times more likely to be removed through MIS compared to tumors in the head. For patients with disease in the body or tail of the pancreas, ethnicity was independently associated with MIS whereby patients of Hispanic origin were less likely to have MIS. The conversion rate to open was 27.7 %, and geographic location was associated with conversion rates.
  
  
  
  MIS procedures comprise approximately 13.5 % of surgical procedures for pancreatic tumors. In addition to tumor histology, differences in surgical approach were identified with respect to ethnicity for patients with tumors in the body/tail of the pancreas.
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
authors.forename: Emmanuel
authors.initials: E
authors.lastname: Gabriel
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA.
authors.forename: Pragatheeshwar
authors.initials: P
authors.lastname: Thirunavukarasu
authors.affiliation: Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA.
authors.forename: Kristopher
authors.initials: K
authors.lastname: Attwood
authors.affiliation: Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA. steven.nurkin@roswellpark.org.
authors.forename: Steven J
authors.initials: SJ
authors.lastname: Nurkin
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery; D000368:Aged; D061887:Conversion to Open Surgery / Q000706:statistics & numerical data; D005260:Female; D006297:Health Services Accessibility; D006801:Humans; D010535:Laparoscopy / Q000706:statistics & numerical data*; D008297:Male; D008875:Middle Aged; D018358:Neuroendocrine Tumors / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000601:surgery*; D044469:Racial Groups / Q000706:statistics & numerical data; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures / Q000706:statistics & numerical data*; D014481:United States
keywords: Disparities; Laparoscopic and robotic surgery; Pancreatic tumors