Locally advanced pancreatic cancer: Is surgical palliation associated with improved clinical outcome relative to medical palliation?

BACKGROUND:The value of palliative surgery in pancreatic cancer is not well-defined. METHODS:We queried the National Cancer Database for patients undergoing curative-intent resection, palliative surgery or medical palliation for clinical stage cT4N0-2M0 pancreatic cancer. Cohorts were 1:1:1 propensity-score-matched for comorbidities and stage. Kaplan-Meier method was used to compare overall survival for matched cohorts. RESULTS:9,107 patients met inclusion criteria: 3,567 (39 ​%) underwent curative intent surgery, 1608 (18 ​%) surgical palliation, 3932 (43 ​%) medical palliation. Patients undergoing resection and surgical palliation had significant hospitalizations (11.0 ​± ​0.4 vs. 10.0 ​± ​0.3 days; p ​= ​0.821) and rates of readmission (8.1 ​% vs. 2.0 ​%; p ​< ​0.001). Patients undergoing surgical palliation demonstrated marginal increases in survival relative to those undergoing medical palliation (8.54 vs. 7.36 months; p ​< ​0.0001). CONCLUSION:In patients undergoing care for locally advanced pancreatic cancer, palliative surgery is associated with marginal improvement in survival but significant lengths of hospitalization and risk of readmission.