Neoadjuvant Radiation Case Volume Is Associated with Improved Margin-Negative Resection Rate in Patients with Pancreatic Cancer

INTRODUCTION: High surgical case volume (SCV) is associated with improved outcomes. We examined the impact of radiation case volume (RCV) on pathologic outcomes among patients (pts) with pancreatic cancer (PC) receiving neoadjuvant therapy (NAT). METHODS: Pts with PC who received NAT between 2009 and 2018 were identified from the National Cancer Database. Institutions were defined by SCV (low: <9, medium: 9 to 35, high: ≥36 pts/y) and RCV (nil: none, low: 1 to 6, high: ≥7 pts/y). Pathologic outcomes were node (N0/N1) and margin (R0/R1) status. RESULTS: In total, 10,893 pts received NAT at 890 institutions; 3,522 (32%) received radiation at 562 (63%) institutions. N0 resection was accomplished in 1,210 (54%) of 2,253 at high-RCV, 3,732 (48%) of 7,736 at low-RCV, and 339 (38%) of 904 at nil-RCV institutions (p < 0.001). R0 margins were achieved in 1,979 (88%) of 2,253 at high-RCV, 6,380 (82%) of 7,736 at low-RCV, and 671 (74%) of 904 at nil-RCV institutions (p < 0.001). Among 3,522 pts who received radiation, N0 resection was not different by RCV: 769 (62%) of 1,241 at high-RCV and 1,461 (64%) of 2,281 at low-RCV institutions (p = 0.22). Pts treated with radiation at high-RCV institutions had higher proportion of R0 margins: 1,120 (90%) of 1,241 at high-RCV and 1,931 (85%) of 2,281 at low-RCV (p < 0.001). High-RCV and low-RCV were each associated with N0 resection (Table ) and were not different (p = 0.33). High-RCV and low-RCV institutions were each associated with R0 margins, but high-RCV was more strongly associated than low-RCV (p < 0.001).TableCONCLUSION: Pts at high-RCV facilities had greater odds of R0 margins independent of SCV.