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National disparities in minimally invasive surgery for pancreatic tumors

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Abstract

Background

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.

Methods

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.

Results

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.

Conclusions

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.

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Acknowledgments

We thank the Commission on Cancer of the American College of Surgeons and American Cancer Society for access to the NCDB Participant User File.

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Authors and Affiliations

  1. Department of Surgical Oncology, Roswell Park Cancer Institute, Carlton House A-206, Elm & Carlton Streets, Buffalo, NY, 14263, USA

    Emmanuel Gabriel, Pragatheeshwar Thirunavukarasu & Steven J. Nurkin

  2. Department of Biostatistics, Roswell Park Cancer Institute, Buffalo, NY, USA

    Kristopher Attwood

Authors
  1. Emmanuel Gabriel
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  2. Pragatheeshwar Thirunavukarasu
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  3. Kristopher Attwood
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  4. Steven J. Nurkin
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Correspondence to Steven J. Nurkin.

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Disclosures

Dr. Gabriel, Dr. Thirunavukarasu, Dr. Attwood and Dr. Nurkin have no conflicts of interest or financial ties to disclose.

Additional information

Disclaimers The American College of Surgeons Committee on Cancer provided the Participant User File from the National Cancer Data Base, but has not reviewed or validated the results or conclusions of our study.

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Gabriel, E., Thirunavukarasu, P., Attwood, K. et al. National disparities in minimally invasive surgery for pancreatic tumors. Surg Endosc 31, 398–409 (2017). https://doi.org/10.1007/s00464-016-4987-6

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  • DOI: https://doi.org/10.1007/s00464-016-4987-6

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