R. K. Schmocker1, D. J. Vanness2, C. C. Greenberg1, H. B. Neuman1, E. R. Winslow1 1University Of Wisconsin,Surgery,Madison, WI, USA 2University Of Wisconsin,Population Health,Madison, WI, USA
Introduction:
Technologies, such as endoscopic ultrasound (EUS), have increased the available staging modalities for patients with resectable pancreatic cancer. However, there currently is not a clear understanding about EUS utilization patterns and impact on management decisions, especially given that tissue diagnosis is not required prior to resection. Therefore, we set out to determine the extent of preoperative EUS use and the factors that increase the likelihood of EUS receipt for patient with resectable pancreatic cancer.
Methods:
We used the Surveillance, Epidemiology, and End Results (SEER) Medicare-linked database to identify patients with pancreatic adenocarcinoma. We included patients ≥66yo with the diagnosis of pancreatic adenocarcinoma, who underwent major pancreatic resection. The date of diagnosis was defined as the first staging procedure within the 6 months prior to surgery, with the staging period extending until the time of surgery. Univariate analysis compared demographic and clinical variables for those with EUS and those without. Logistic regression was used to determine factors most associated with preoperative EUS. The main outcome was EUS use in the staging period. Patient and disease factors associated with receipt of EUS were also identified. Secondary outcomes were number of staging tests, and time to surgery.
Results:
2,782 patients were included, 55% female with an average age of 74.7±5.5 years. 72% had regional disease (n=2002), and 56% were treated at an academic hospital (n=1563). Of all operations, 83.4% (2321/2782) had a proximal, total, or other pancreatectomy. 1204 patients underwent EUS (43.3%). On logistic regression the factors most strongly associated with receipt of EUS were: date of diagnosis, SEER area, a NCI or academic hospital, and a gastroenterologist as the first consultant (Table). Additionally, on multivariate regression, EUS was associated with mean increased time to surgery (17.79 days; p<0.0001), and independently associated with an increased number of staging tests (40 tests per 100 patients; p<0.0001).
Conclusion:
EUS is commonly used in the preoperative period, despite guidelines stating that tissue diagnosis is not required prior to surgery. Factors most associated with receipt of EUS are most strongly associated with geographic, temporal, and institutional factors, not clinical/disease factors. Additionally, patients with EUS had a longer time to surgery and an increase in the number of staging tests. This suggests that EUS may be overused in patients with resectable disease, with an increased cost and treatment delay without clearly adding clinical value.
