Geographic disparities in surgical treatment recommendation patterns and survival for pancreatic adenocarcinoma

Previous studies have described pessimistic attitudes of physicians toward recommending surgery for early-stage pancreatic adenocarcinoma. However, the impact of geographic region on recommendation patterns of surgical treatment for potentially resectable pancreatic cancer is unknown. The SEER registry was used to identify patients with early-stage pancreatic adenocarcinoma (AJCC I-II) [2004–2013]. The exposure of interest was geographic region of diagnosis: Midwest, West, Southeast or Northeast. The endpoints of interest were recommendation of no surgery, and overall survival. A total of 24,408 patients were identified [Midwest – 10.6%, West – 50.1%, Southeast – 21.7% and Northeast – 17.6%]. Overall, 38% of patients had a recommendation of no surgery by their provider. On univariate analysis, the likelihood of having a recommendation of no surgery was lowest in the NE [OR: Northeast (0.8), West (1.6), Southeast (1.3), and Midwest (Ref); p