Adjuvant chemotherapy following pancreaticoduodenectomy for pancreatic ductal adenocarcinoma – inter-hospital variability in uptake

Abstract

Introduction: Evidence from randomised controlled trials supports adjuvant chemotherapy following resection for pancreatic ductal adenocarcinoma (PDAC), showing clear survival benefit. Though pancreatic surgery in the United Kingdom is centralised, provision of chemotherapy is not, being given in the local hospital. This study assessed the administration of adjuvant chemotherapy following pancreaticoduodenectomy (PD) for PDAC, focusing on rates of administration and how these differed between the 14 hospitals that delivered this service. Methods: A prospectively maintained database was reviewed, and patients undergoing PD for PDAC between January 2007 and December 2015 were identified for inclusion (N=272), although data were missing for 4 patients (1.5%). Data were collected on whether adjuvant chemotherapy was given and the hospital where chemotherapy was administered. Chemotherapy uptake rates were compared between sites using Fisher's exact test. Results: Adjuvant chemotherapy was administered to 67% (N=180/268) of patients. There was generally similar provision of chemotherapy between hospitals, with the majority providing chemotherapy to between 71 and 82% of their patients. However, there were two hospitals with low provision of chemotherapy (54 and 30% respectively), resulting in a statistically significant difference between the hospitals (p=0.015). Conclusion: In spite of current level 1A evidence supporting the use of adjuvant chemotherapy after resection for PDAC, there is significant variability between hospitals who provide this therapy. Though centralisation may not be needed to the same extent as surgery, individual hospitals practice should be audited. Ensuring equality of provision of chemotherapy may be a simple way to improve outcomes after PD for PDAC.