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Proclivity to Explore Locally Advanced Pancreas Cancer Is Not Associated with Surgeon Volume

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery

Abstract

Background and Purpose

There is limited high-level evidence to guide locally advanced pancreas cancer (LAPC) management. Recent work shows that surgeons’ preferences in LAPC management vary broadly. We sought to examine whether surgeon volume was associated with attitudes regarding LAPC management.

Methods

An electronic survey was distributed by email to an international cohort of pancreas surgeons to evaluate practice patterns regarding LAPC management. Clinical vignette-based questions evaluated surgeons’ attitudes regarding patient eligibility and the proclivity to offer exploration. Surgeons were classified into “low-“ or “high-volume” categories according to thresholds of self-reported annual pancreatectomy volume. Surgeon’s attitudes regarding LAPC management and inclination to consider exploration were compared across annual volume categories.

Results

A total of 153 eligible responses were received from 4 continents, for an estimated response rate of 10.6%. Median duration of practice was 12 years (IQR 6–20). Most respondents reported >25 cases/year (89, 58.2%), of which 34 (22.2%) reported >50. Compared to surgeons with <25 cases/year, surgeons with >25 cases/year practiced longer (median 15 vs. 7.5 years, P<0.001) and were more likely to “always” recommend neoadjuvant chemotherapy (83.2% vs. 56.3%, P=0.001). Surgeons performing >50 cases/year were more likely to offer arterial resection (70.6% vs. 43.7%, P=0.006). The willingness to offer (or defer) exploration did not differ across any categories of surgeons’ annual case volume.

Conclusions

In an international survey of pancreas surgeons, the proclivity to consider exploration for LAPC was not associated with multiple categories of surgeon volume. Better evidence is needed to define the optimal management approach to LAPC.

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Author information

Authors and Affiliations

  1. Department of Surgery, Johns Hopkins Hospital, Baltimore, MD, USA

    Alex B. Blair & Jin He

  2. Department of Surgery, Brooke Army Medical Center, Fort Sam Houston, TX, USA

    Robert W. Krell

  3. Department of Surgery, Ohio State University, Columbus, OH, USA

    Aslam Ejaz

  4. Department of Surgery, UMC Utrecht Cancer Center, University Medical Center Utrecht, Utrecht, The Netherlands

    Vincent P. Groot

  5. Department of Surgery, University of Glasgow School of Medicine, Glasgow, UK

    Georgios Gemenetzis

  6. Department of Surgery, Division of Surgical Oncology, University of Nebraska Medical Center, 986880 Nebraska Medical Center, Omaha, NE, 68198, USA

    James C. Padussis, Chandrakanth Are & Bradley N. Reames

  7. Department of Surgery, Università Vita-Salute, San Raffaele Hospital IRCCS, Milano, Italy

    Massimo Falconi

  8. Department of Surgery, New York University Langone Medical Center, New York, NY, USA

    Christopher L. Wolfgang

  9. Department of Surgery, Northwell Health, Manhasset, NY, USA

    Matthew J. Weiss

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Contributions

Design, acquisition analysis, or interpretation of data for the work: ABB, RWK, AE, VPG, GG, JCP, MF, CLW, MJW, CA, JH, and BNR. Drafting the manuscript: ABB and BNR. Critical revision of the manuscript: ABB, RWK, AE, VPG, GG, JCP, MF, CLW, MJW, CA, JH, and BNR. Final approval of the version to be published: ABB, RWK, AE, VPG, GG, JCP, MF, CLW, MJW, CA, JH, and BNR. Agreement to be accountable for all aspects of the work in regard to accuracy or integrity: ABB, RWK, AE, VPG, GG, JCP, MF, CLW, MJW, CA, JH, and BNR.

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Correspondence to Bradley N. Reames.

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Blair, A.B., Krell, R.W., Ejaz, A. et al. Proclivity to Explore Locally Advanced Pancreas Cancer Is Not Associated with Surgeon Volume. J Gastrointest Surg 25, 2562–2571 (2021). https://doi.org/10.1007/s11605-021-05034-w

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