Effect of surgeon specialty and health system characteristics on outcomes after pancreatic adenocarcinoma resection.

Abstract

663 Background: Outcomes for pancreatic adenocarcinoma patients have improved with multidisciplinary care and centralization at high-volume centers. While surgeon and hospital volume have been linked to improved short-term mortality, the extent to which surgeon specialty influences long-term survival and through which mechanisms remain unclear. Methods: We analyzed SEER-Medicare data (2000–2020) for patients with pancreatic adenocarcinoma undergoing resection. Self-reported surgeon specialty (surgical oncologist vs general surgeon) was identified using the Medicare Provider Enrollment, Chain and Ownership System data (2008–2020) and validated with Medicare Plan B data (full sample). The primary outcome was overall survival (time from cancer diagnosis to death). Results: Among 10,201 resections (median age 74 years; 51% female; 79% pancreatoduodenectomy), surgeries by surgical oncologists were more often at teaching hospitals, NCI-designated centers, and high-volume practices. These patients were more likely white, higher-income, earlier tumor stage, more frequently received multimodality therapy, and had lower complication rates, shorter length of stay, lower rate of futile surgery (cancer-related death within 6 months of surgery), and longer median survival (19 vs 17 months, p<0.001). The survival advantage persisted across time periods and facility types. After risk adjustment, factors associated with longer survival included younger age, female sex, lower comorbidity, higher socioeconomic status, earlier tumor stage, later treatment period, teaching hospital status, NCI designation, distal pancreatectomy (vs pancreatoduodenectomy), and higher surgeon volume, but not surgeon specialty. Sensitivity analyses using Medicare Plan B specialty definition confirmed these findings. Conclusions: While unadjusted outcomes were superior after resections by surgical oncologists, these benefits were largely mediated through patient and system-level factors, such as earlier diagnosis and centralization at high-volume, multidisciplinary cancer centers. Therefore, surgical oncologist specialty may serve as a proxy for access to comprehensive oncologic care, which is critical in improving survival after pancreatic cancer surgery.