Performing vascular reconstruction (VR) during surgical resection for pancreatic cancer is associated with a greater likelihood of postoperative adverse outcomes than resection alone, say US researchers.
The team, led by Rebekah White, from Duke University Medical Center in Durham, North Carolina, notes: "Future studies investigating shared decision-making between patients and physicians should be conducted given the trade-offs imposed by the immediate risk for mortality and the potential benefit of long-term survival."
The Nationwide Inpatient Sample for 2000-2009 was examined, and 10,206 patients with pancreatic cancer who underwent resection were included. VR was performed in 4.0% of patients, ranging from 1.2% in the lowest hospital volume quartile to 6.5% in the highest hospital volume quartile. The rate of VR increased from 0.7% in 2000 to 6.0% in 2009, at an odds ratio of 1.11 per year.
Multivariate and propensity score (PS)-adjusted analyses revealed similar findings to those of unadjusted analyses. The rate of intraoperative complications was higher in patients who underwent VR than those who did not, at a PS-adjusted odds ratio (PSOR) of 1.94. This was largely due to an increased rate of intraoperative hemorrhage, at a PSOR of 2.67.
In addition, patients who underwent VR had a greater rate of postoperative complications than those who did not, at a PSOR of 1.36. Patients who did not undergo VR also had a significantly lower predicted number of complications. Interestingly, hospitals in the highest quartile of surgical volume had even higher PSORs of intraoperative and postoperative complications.
There were no differences between those who had VR and those who did not in terms of mortality and reintervention rate, although patients who underwent VR required more blood products. Furthermore, mortality was significantly higher with VR in high-volume hospitals. The median length of hospital stay was similar in the two groups, at 12.3 days.
In an accompanying invited critique in the Archives of Surgery, E Christopher Ellison, from Ohio State University Wexmer Medical Center in Columbus, USA, comments: "As we move into an era of value-based reimbursement, we have a collective responsibility to economically justify our treatments… It follows that the cost for the total care for patients with pancreatic cancer must be included in future comparative effectiveness research."
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