Annals of Surgical Oncology

, Volume 26, Issue 1, pp 98–108 | Cite as

Correlates of Refusal of Surgery in the Treatment of Non-metastatic Pancreatic Adenocarcinoma

  • Alex Coffman
  • Anna Torgeson
  • Shane LloydEmail author
Pancreatic Tumors



Surgical resection is the most important therapeutic intervention for eligible patients with pancreatic cancer; however, a majority of patients never receive surgery for a variety of reasons, including patient refusal. Utilizing the National Cancer Database, we investigated the associated sociodemographic and clinical factors for those patients who refused surgery, and the impact of this decision on overall survival (OS).

Methods and Materials

We analyzed adult patients with non-metastatic adenocarcinoma of the pancreas diagnosed from 2004 to 2013. Univariate and multivariate logistic regression modeling was used to identify factors predictive of refusing surgery, and Kaplan–Meier and log-rank analysis was performed to investigate the effect on OS.


A total of 48,902 patients were identified: 47,107 received surgery (96.3%) and 1795 were offered surgery but refused (3.7%). Factors associated with refusing surgery include both sociodemographic factors [age > 50 years, female sex, Black race, non-private insurance, treatment at a non-academic institution or non-metro facility, Carlson Comorbidity Index of 2 + (p ≤ 0.01)], and clinical factors [advanced clinical T (tumor) category and tumor size > 20 cm (p ≤ 0.01)]. Patients who refused surgery and received no treatment at all experienced a median survival of 5.1 months, while those who refused surgery but received chemoradiotherapy experienced a median survival of 11.2 months. As an index for comparison, those who received surgery had a median survival of 20.5 months.


Refusing surgery is an understudied phenomenon associated with several sociodemographic and clinical factors. The expected prognosis for patients who refuse surgery is presented.

Supplementary material

10434_2018_6708_MOESM1_ESM.docx (45 kb)
Supplementary material 1 (DOCX 44 kb)


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Copyright information

© Society of Surgical Oncology 2018

Authors and Affiliations

  1. 1.Department of Radiation MedicineLoma Linda University Medical CenterLoma LindaUSA
  2. 2.Department of Radiation OncologyHuntsman Cancer Institute, University of UtahSalt Lake CityUSA

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