Sociodemographic variation in the utilization of minimally invasive surgical approaches for pancreatic cancer

IF 2.7 3区医学 Q2 GASTROENTEROLOGY & HEPATOLOGY

Hpb Pub Date : 2024-10-01 DOI:10.1016/j.hpb.2024.07.403

Andy Tran , Richard Zheng , Fabian Johnston , Jin He , William R. Burns , Christopher Shubert , Kelly Lafaro , Richard A. Burkhart

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引用次数: 0

Abstract

Background

Minimally invasive pancreatic surgery (MIPS), when selectively utilized, has been shown to hasten recovery with outcomes comparable to open approaches, but access may not be equitable. This study explored variation in utilization of MIPS for pancreatic cancer.

Methods

The National Cancer Database was queried to identify patients diagnosed with a primary pancreatic neoplasm from 2010 to 2020. Study participants had diagnoses of clinical or pathologic stage 1–3 disease and received curative-intent surgery. Multivariable analyses assessed the association between surgical approach and patient and disease factors.

Results

Inclusion criteria identified 73,137 patients: 51,408 underwent open surgery and 21,729 received MIPS. In our multivariable analysis, Black race was associated with reduced odds of MIPS (AOR 0.88; p = 0.02), while older age (AOR 1.17; p = 0.01), later year of diagnosis (AOR 1.57; p < 0.001), and private insurance coverage (AOR 1.30; p = 0.05) were associated with increased odds. When patients with adenocarcinoma were analyzed in isolation, disparities in MIPS utilization persisted even when controlling for disease stage.

Conclusion

Sociodemographic factors like age, race, and insurance coverage appear to vary in the utilization of MIPS technologies for the treatment of pancreatic malignancy. Addressing variation with robust mixed methods approaches in the future is proposed to incorporate prospective interventions with highly annotated outcomes for additional study.

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利用微创手术治疗胰腺癌的社会人口学差异

背景有选择地使用微创胰腺手术（MIPS）已被证明可加快康复，其效果与开放式手术相当，但使用机会可能并不公平。本研究探讨了胰腺癌微创胰腺手术（MIPS）利用率的差异。方法通过查询美国国家癌症数据库，确定了2010年至2020年期间诊断为原发性胰腺肿瘤的患者。研究参与者被诊断为临床或病理 1-3 期疾病，并接受了治愈性手术。多变量分析评估了手术方式与患者和疾病因素之间的关联：51,408人接受了开放手术，21,729人接受了MIPS手术。在我们的多变量分析中，黑人种族与 MIPS 的几率降低有关（AOR 0.88；P = 0.02），而年龄较大（AOR 1.17；P = 0.01）、诊断年份较晚（AOR 1.57；P <；0.001）和私人保险覆盖范围（AOR 1.30；P = 0.05）与几率增加有关。结论年龄、种族和保险范围等社会人口因素似乎在利用 MIPS 技术治疗胰腺恶性肿瘤方面存在差异。建议今后采用稳健的混合方法来解决差异问题，以纳入具有高度注释结果的前瞻性干预措施，进行更多研究。

本文章由计算机程序翻译，如有差异，请以英文原文为准。

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来源期刊

Hpb GASTROENTEROLOGY & HEPATOLOGY-SURGERY

CiteScore

5.60

自引率

3.40%

发文量

244

审稿时长

57 days

期刊介绍： HPB is an international forum for clinical, scientific and educational communication. Twelve issues a year bring the reader leading articles, expert reviews, original articles, images, editorials, and reader correspondence encompassing all aspects of benign and malignant hepatobiliary disease and its management. HPB features relevant aspects of clinical and translational research and practice. Specific areas of interest include HPB diseases encountered globally by clinical practitioners in this specialist field of gastrointestinal surgery. The journal addresses the challenges faced in the management of cancer involving the liver, biliary system and pancreas. While surgical oncology represents a large part of HPB practice, submission of manuscripts relating to liver and pancreas transplantation, the treatment of benign conditions such as acute and chronic pancreatitis, and those relating to hepatobiliary infection and inflammation are also welcomed. There will be a focus on developing a multidisciplinary approach to diagnosis and treatment with endoscopic and laparoscopic approaches, radiological interventions and surgical techniques being strongly represented. HPB welcomes submission of manuscripts in all these areas and in scientific focused research that has clear clinical relevance to HPB surgical practice. HPB aims to help its readers - surgeons, physicians, radiologists and basic scientists - to develop their knowledge and practice. HPB will be of interest to specialists involved in the management of hepatobiliary and pancreatic disease however will also inform those working in related fields. Abstracted and Indexed in: MEDLINE® EMBASE PubMed Science Citation Index Expanded Academic Search (EBSCO) HPB is owned by the International Hepato-Pancreato-Biliary Association (IHPBA) and is also the official Journal of the American Hepato-Pancreato-Biliary Association (AHPBA), the Asian-Pacific Hepato Pancreatic Biliary Association (A-PHPBA) and the European-African Hepato-Pancreatic Biliary Association (E-AHPBA).