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Assessment of textbook oncologic outcomes following pancreaticoduodenectomy for pancreatic adenocarcinoma
Author(s) -
Sweigert Patrick J.,
Eguia Emanuel,
Baker Marshall S.,
Paredes Anghela Z.,
Tsilimigras Diamantis I.,
Dillhoff Mary,
Ejaz Aslam,
Cloyd Jordan,
Tsung Allan,
Pawlik Timothy M.
Publication year - 2020
Publication title -
journal of surgical oncology
Language(s) - English
Resource type - Journals
SCImago Journal Rank - 1.201
H-Index - 111
eISSN - 1096-9098
pISSN - 0022-4790
DOI - 10.1002/jso.25861
Subject(s) - medicine , medicaid , pancreaticoduodenectomy , logistic regression , odds ratio , proportional hazards model , pancreatectomy , adenocarcinoma , adjuvant therapy , cancer , pancreatic cancer , oncology , surgery , health care , pancreas , economics , economic growth
Abstract Background Composite outcomes may more accurately reflect patient and provider expectations around optimal care. We sought to determine the impact of achieving a so‐called “textbook oncologic outcome” (TOO) among patients undergoing resection of pancreatic adenocarcinoma (PDAC). Methods Patients undergoing pancreaticoduodenectomy (PD) for PDAC between 2006 and 2016 were identified in the National Cancer Database (NCDB). TOO was defined by: margin negative resection, compliant lymph node evaluation, no prolonged length‐of‐stay, no 30‐day readmission/mortality, and receipt of adjuvant chemotherapy. Factors associated with TOO and overall survival (OS) were evaluated using multivariable logistic and Cox regression models, respectively. Results Among 18 608 patients who underwent PD at 782 hospitals, many patients successfully achieved certain TOO factors such as R0 margin (77.9%) and no 30‐day mortality (96.9%), while other TOO criteria such as receipt of adjuvant therapy (48.2%) were achieved less frequently. Overall, only 3124 (16.8%) patients achieved a TOO. Factors associated with lower odds of TOO included: older age, Black race, Medicaid insurance, Community facility, and low PD facility (<20 PD/y) (all P < .05). Achievement of a TOO was associated with lower risk of mortality (HR 0.74; 95% CI, 0.70‐0.77). Conclusions While TOO was associated with improved long‐term survival, TOO was only achieved in 16.8% of patients undergoing PD.