title: Type of Resection (Whipple vs. Distal) Does Not Affect the National Failure to Provide Post-resection Adjuvant Chemotherapy in Localized Pancreatic Cancer.
abstract: BACKGROUND
  Adjuvant chemotherapy improves survival after curative intent resection for localized pancreatic adenocarcinoma (PDAC). Given the differences in perioperative morbidity, we hypothesized that patients undergoing distal partial pancreatectomy (DPP) would receive adjuvant therapy more often those undergoing pancreatoduodenectomy (PD).
  
  
  METHODS
  The National Cancer Data Base (2004-2012) identified patients with localized PDAC undergoing DPP and PD, excluding neoadjuvant cases, and factors associated with receipt of adjuvant therapy were identified. Overall survival (OS) was analyzed using multivariable Cox proportional hazards regression.
  
  
  RESULTS
  Overall, 13,501 patients were included (DPP, n = 1933; PD, n = 11,568). Prognostic characteristics were similar, except DPP patients had fewer N1 lesions, less often positive margins, more minimally invasive resections, and shorter hospital stay. The proportion of patients not receiving adjuvant chemotherapy was equivalent (DPP 33.7%, PD 32.0%; p = 0.148). The type of procedure was not independently associated with adjuvant chemotherapy (hazard ratio 0.96, 95% confidence interval 0.90-1.02; p = 0.150), and patients receiving adjuvant chemotherapy had improved unadjusted and adjusted OS compared with surgery alone. The type of resection did not predict adjusted mortality (p = 0.870).
  
  
  CONCLUSIONS
  Receipt of adjuvant chemotherapy did not vary by type of resection but improved survival independent of procedure performed. Factors other than type of resection appear to be driving the nationwide rates of post-resection adjuvant chemotherapy in localized PDAC.
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: John R
authors.initials: JR
authors.lastname: Bergquist
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Tommy
authors.initials: T
authors.lastname: Ivanics
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.|Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Christopher R
authors.initials: CR
authors.lastname: Shubert
authors.affiliation: Robert D. and Patricia E. Kern Center for the Science of Health Care Delivery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Elizabeth B
authors.initials: EB
authors.lastname: Habermann
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Rory L
authors.initials: RL
authors.lastname: Smoot
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael L
authors.initials: ML
authors.lastname: Kendrick
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: David M
authors.initials: DM
authors.lastname: Nagorney
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA.
authors.forename: Michael B
authors.initials: MB
authors.lastname: Farnell
authors.affiliation: Division of Hepatobiliary Surgery, Section of Subspecialty General Surgery, Department of Surgery, Mayo Clinic, Rochester, MN, USA. truty.mark@mayo.edu.
authors.forename: Mark J
authors.initials: MJ
authors.lastname: Truty
mesh_terms: D000230:Adenocarcinoma / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D017024:Chemotherapy, Adjuvant / Q000401:mortality*; D003131:Combined Modality Therapy; D016208:Databases, Factual; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D008297:Male; D008875:Middle Aged; D009361:Neoplasm Invasiveness; D010180:Pancreatectomy / Q000401:mortality*; D010190:Pancreatic Neoplasms / Q000188:drug therapy / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012189:Retrospective Studies; D015996:Survival Rate