Factors associated with failure to operate and its impact on survival in early-stage pancreatic cancer

Gilbert Z. Murimwa, John D. Karalis, Jennie Meier, Mithin Nehrubabu, Micah Thornton, Matthew Porembka, Sam Wang, Herbert J. Zeh, Adam C. Yopp, Patricio M. Polanco

Research output: Contribution to journalArticlepeer-review

3 Scopus citations

Abstract

Introduction: Curative intent for localized pancreatic cancer (pancreatic ductal adenocarcinoma [PDAC]) requires surgery, but despite improved perioperative outcomes, surgery remains underutilized. This study analyzed the Texas Cancer Registry (TCR) to identify resectable PDAC patients who underwent curative-intent surgery in Texas between 2004 and 2018. We then evaluated demographic and clinical factors associated with failure to operate and survival (OS). Methods: We identified patients with localized PDAC or regional lymph node spread between 2004 and 2018 in the TCR. Resection rates were determined and multivariable regression and cox proportional hazards were used to identify factors associated with failure to OS. Results: Of 4274 patients, 22% underwent resection, 57% were not offered surgery, 6% had comorbidities precluding surgery, and 3% refused. Resection rates decreased from 31% in 2004 to 22% in 2018. Increasing age was associated with failure to operate (odds ratio [OR] 2.55; 95% confidence interval [CI] 1.80–3.61; p < 0.0001) while treatment at a Commission on Cancer (CoC) center correlated with reduced failure to operate (OR 0.63; 95% CI 0.50–0.78; p < 0.0001). Resection correlated with survival (HR 0.34; 95% CI 0.31-0.38; p < 0.0001) as did treatment at a National Cancer Institute (NCI)-designated center (hazard ratio 0.79; 95% CI 0.70–0.89; p < 0.0001). Conclusions: Surgery is underutilized for the treatment of resectable PDAC in Texas with decreasing utilization, annually. Evaluation at CoC was associated with improved resection rates and NCI was associated with increased survival. Expanding access to multidisciplinary care including trained hepato-pancreatico-biliary surgeons may improve outcomes for PDAC patients.

Original languageEnglish (US)
Pages (from-to)540-548
Number of pages9
JournalJournal of Surgical Oncology
Volume128
Issue number4
DOIs
StatePublished - Sep 15 2023

Keywords

  • pancreatic cancer
  • surgical oncology
  • treatment disparities

ASJC Scopus subject areas

  • Surgery
  • Oncology

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