Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma

Aitua Salami, Nkosi H Alvarez, Amit R T Joshi

Research output: Contribution to journalArticlepeer-review

8 Scopus citations


BACKGROUND: Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown.

METHODS: The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004-2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival.

RESULTS: A total of 24,408 patients were identified [Midwest - 10.6%, West - 50.1%, Southeast - 21.7% and Northeast - 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p < 0.05 for all]. This association persisted following risk adjustment. Geographic region was an independent predictor of mortality, irrespective of resection status.

CONCLUSION: Significant disparities in surgical treatment recommendation patterns and survival for early-stage pancreatic cancer exist based on geographic location. Improved adherence to guideline-driven treatment recommendations, standardization of care processes, and regionalization may help stem the existing variability in care and outcomes.

Original languageEnglish (US)
Pages (from-to)1008-1015
Number of pages8
Issue number11
StatePublished - Nov 2017
Externally publishedYes

Bibliographical note

Copyright © 2017 International Hepato-Pancreato-Biliary Association Inc. Published by Elsevier Ltd. All rights reserved.


  • Adenocarcinoma/mortality
  • Aged
  • Aged, 80 and over
  • Chi-Square Distribution
  • Female
  • Healthcare Disparities/trends
  • Humans
  • Logistic Models
  • Male
  • Middle Aged
  • Multivariate Analysis
  • Neoplasm Staging
  • Odds Ratio
  • Pancreatectomy/adverse effects
  • Pancreatic Neoplasms/mortality
  • Practice Patterns, Physicians'/trends
  • Process Assessment, Health Care/trends
  • Proportional Hazards Models
  • Retrospective Studies
  • Risk Factors
  • SEER Program
  • Time Factors
  • Treatment Outcome
  • United States/epidemiology

PubMed: MeSH publication types

  • Comparative Study
  • Journal Article


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