title: Impact of minimally invasive vs. open distal pancreatectomy on use of adjuvant chemoradiation for pancreatic adenocarcinoma.
abstract: BACKGROUND
  Published data examining the impact of minimally invasive distal pancreatectomy (MIDP) on survival are generally limited to experiences from high-volume institutions. Our aim was to compare utilization of adjuvant chemoradiation and time from surgery until its initiation following MIDP vs. open surgery (ODP) at a national level.
  
  
  METHODS
  Adult patients undergoing distal pancreatectomy for Stage I and II pancreatic adenocarcinoma were identified from the National Cancer Data Base, 2010-2012.
  
  
  RESULTS
  A total of 1807 patients underwent distal pancreatectomy for adenocarcinoma at 506 institutions (27.9% MIDP). After adjustment, those who underwent MIDP were more likely to have complete tumor resections and a shorter hospital length of stay. Patients undergoing MIDP vs. ODP were more likely to receive adjuvant chemotherapy; time to initiation of adjuvant chemotherapy or radiation was not different between groups. After adjustment, overall survival for MIDP vs. ODP remained similar (HR 0.85, CI 0.67-1.10, p = 0.21).
  
  
  CONCLUSIONS
  MIDP is associated with increased use of adjuvant chemotherapy; further study is needed to understand the etiology and impact of this association.
authors.affiliation: Duke University School of Medicine, Durham, NC 27710, USA. Electronic address: kla24@duke.edu.
authors.forename: Kevin L
authors.initials: KL
authors.lastname: Anderson
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA. Electronic address: mohamed.adam@dm.duke.edu.
authors.forename: Mohamed A
authors.initials: MA
authors.lastname: Adam
authors.affiliation: Department of Biostatistics and Bioinformatics, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, 20 Duke Medicine Circle, Durham, NC 27710, USA. Electronic address: samantha.thomas@dm.duke.edu.
authors.forename: Samantha
authors.initials: S
authors.lastname: Thomas
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, 20 Duke Medicine Circle, Durham, NC 27710, USA. Electronic address: sanziana.roman@dm.duke.edu.
authors.forename: Sanziana A
authors.initials: SA
authors.lastname: Roman
authors.affiliation: Department of Surgery, Duke University Medical Center, Durham, NC 27710, USA; Duke Cancer Institute, 20 Duke Medicine Circle, Durham, NC 27710, USA; Department of Medicine, Duke University Medical Center, Durham, NC 27710, USA; Duke Clinical Research Institute, Durham, NC 27710, USA. Electronic address: julie.sosa@dm.duke.edu.
authors.forename: Julie A
authors.initials: JA
authors.lastname: Sosa
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000628:therapy*; D000368:Aged; D017024:Chemotherapy, Adjuvant / Q000706:statistics & numerical data*; D016208:Databases, Factual; D005260:Female; D006801:Humans; D010535:Laparoscopy; D007902:Length of Stay / Q000706:statistics & numerical data; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000628:therapy*; D018714:Radiotherapy, Adjuvant / Q000706:statistics & numerical data*; D012189:Retrospective Studies; D065287:Robotic Surgical Procedures; D014481:United States / Q000453:epidemiology
keywords: Adjuvant chemotherapy; Adjuvant radiation; Distal pancreatectomy; Minimally invasive; Outcomes; Pancreatic adenocarcinoma