Abstract:
BACKGROUND:Surgical resection is the most important therapeutic intervention for eligible patients with pancreatic cancer; however, a majority of patients never receive surgery for a variety of reasons, including patient refusal. Utilizing the National Cancer Database, we investigated the associated sociodemographic and clinical factors for those patients who refused surgery, and the impact of this decision on overall survival (OS). METHODS AND MATERIALS:We analyzed adult patients with non-metastatic adenocarcinoma of the pancreas diagnosed from 2004 to 2013. Univariate and multivariate logistic regression modeling was used to identify factors predictive of refusing surgery, and Kaplan-Meier and log-rank analysis was performed to investigate the effect on OS. RESULTS:A total of 48,902 patients were identified: 47,107 received surgery (96.3%) and 1795 were offered surgery but refused (3.7%). Factors associated with refusing surgery include both sociodemographic factors [age > 50 years, female sex, Black race, non-private insurance, treatment at a non-academic institution or non-metro facility, Carlson Comorbidity Index of 2 + (p ≤ 0.01)], and clinical factors [advanced clinical T (tumor) category and tumor size > 20 cm (p ≤ 0.01)]. Patients who refused surgery and received no treatment at all experienced a median survival of 5.1 months, while those who refused surgery but received chemoradiotherapy experienced a median survival of 11.2 months. As an index for comparison, those who received surgery had a median survival of 20.5 months. CONCLUSION:Refusing surgery is an understudied phenomenon associated with several sociodemographic and clinical factors. The expected prognosis for patients who refuse surgery is presented.
journal_name
Ann Surg Oncoljournal_title
Annals of surgical oncologyauthors
Coffman A,Torgeson A,Lloyd Sdoi
10.1245/s10434-018-6708-ysubject
Has Abstractpub_date
2019-01-01 00:00:00pages
98-108issue
1eissn
1068-9265issn
1534-4681pii
10.1245/s10434-018-6708-yjournal_volume
26pub_type
杂志文章abstract:BACKGROUND:Calciphylaxis is a rare condition associated with chronic renal failure and entails a very poor prognosis. Pathogenesis is poorly understood but involves abnormalities in calcium and phosphorus metabolism that lead to vascular and extravascular calcification. Patients present with painful ulcerating plaques ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/ASO.2006.03.042
更新日期:2006-01-01 00:00:00
abstract:BACKGROUND:The serum neutrophil-lymphocyte ratio (NLR) is associated with outcomes in several solid organ cancers, including hepatocellular carcinoma (HCC). METHODS:We reviewed our experience in patients with HCC who underwent transarterial chemoembolization (TACE) as the initial treatment. Serum complete blood counts...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-012-2639-1
更新日期:2013-03-01 00:00:00
abstract:BACKGROUND:Data on the importance of margin status after total thyroidectomy for papillary thyroid cancer (PTC) remain limited. This study sought to identify factors associated with positive margins and to determine the impact of positive margins on survival for patients with PTC. METHODS:The National Cancer Data Base...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-4867-7
更新日期:2016-02-01 00:00:00
abstract:OBJECTIVE:To appreciate if the ovaries can be preserved in selected young women with peritoneal carcinomatosis (PC). BACKGROUND:The traditional rule is to resect the ovaries systematically when PC is found at surgery. METHODS:A new policy was developed to preserve the ovaries when they were macroscopically normal in ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-2879-8
更新日期:2013-06-01 00:00:00
abstract:BACKGROUND:Parenchyma-preserving resections (PPRs), including enucleation and middle pancreatectomy (MP), are accepted procedures for insulinomas, but their role in the treatment of nonfunctioning pancreatic endocrine tumors (NF-PETs) is debated. The aim of this study was to evaluate perioperative and long-term outcome...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-010-0949-8
更新日期:2010-06-01 00:00:00
abstract:BACKGROUND:Peritoneal carcinomatosis (PC), which has hitherto been regarded as a lethal entity, can now be cured with surgery (treating macroscopic tumor seeding) combined with hyperthermic intraperitoneal chemotherapy (HIPEC) (treating residual microscopic disease). The purpose of this study was to analyze the morbidi...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-007-9348-1
更新日期:2007-06-01 00:00:00
abstract:BACKGROUND:Current nodal staging (N-staging) of ampullary carcinoma in the TNM staging system distinguishes between node-negative (N0) and node-positive (N1) disease but does not consider the metastatic lymph node (LN) number. METHODS:Overall, 313 patients who underwent pancreatoduodenectomy for ampullary adenocarcino...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-4499-y
更新日期:2015-12-01 00:00:00
abstract:BACKGROUND:COX inhibitors and beta-blockers were recently suggested to reduce cancer progression through inhibition of tumor proliferation and growth factor secretion, induction of tumor apoptosis, and prevention of cellular immune suppression during the critical perioperative period. Here we evaluated the perioperativ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-008-9890-5
更新日期:2008-07-01 00:00:00
abstract:PURPOSE:To assess patterns of uptake and outcomes of laparoscopic colon and rectal cancer surgery in Ontario, and the potential influence of surgical fee incentives instituted on October 1, 2005. METHODS:We used Ontario administrative databases from fiscal years 2002 to 2009. Study outcomes were uptake rates of laparo...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3123-2
更新日期:2013-11-01 00:00:00
abstract:BACKGROUND:Although pancreatic cancer is the fourth leading cause of cancer death, few studies have evaluated population-based trends in diagnosis, management, and outcome. METHODS:We used the Surveillance, Epidemiology, and End Results (SEER) registry to evaluate treatment trends and outcomes for patients 18 or older...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-006-9249-8
更新日期:2007-04-01 00:00:00
abstract:BACKGROUND:The impact of re-resection of a positive intraoperative bile duct margin on clinical outcomes for resectable hilar cholangiocarcinoma (HCCA) remains controversial. We sought to define the impact of re-resection of an initially positive frozen-section bile duct margin on outcomes of patients undergoing surger...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-018-6382-0
更新日期:2018-05-01 00:00:00
abstract:BACKGROUND:Girdin was identified as a novel Akt substrate that contributes to a positive feedback loop between Girdin and Akt. Although several recent studies have demonstrated that Girdin is involved in tumor metastasis, the clinical implications of Girdin in breast cancer remain unclear. METHODS:To retrospectively e...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3746-y
更新日期:2014-12-01 00:00:00
abstract:OBJECTIVES:To reject the hypothesis that the number of nodes removed at time of surgical staging for vulva cancer is not an important prognostic factor. METHODS:Retrospective chart reviews were carried out from 1980-2004 to identify patients with squamous cell vulva carcinoma treated with radical vulvectomy and bilate...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-007-9417-5
更新日期:2007-07-01 00:00:00
abstract:BACKGROUND:Initial therapy for early hepatocellular carcinoma (HCC) with well-compensated cirrhosis is controversial. While we previously reported on the effect of clinical factors and surgeon specialty on choice of therapy for early HCC, other nonclinical factors also may impact decision-making. METHODS:Surgeons who ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-012-2619-5
更新日期:2013-02-01 00:00:00
abstract:BACKGROUND:The National Comprehensive Cancer Network (NCCN) recommends that at least 15 lymph nodes (LNs) be removed during radical gastrectomy. This study aims to investigate the optimal number of LNs resected for radical gastrectomy. PATIENTS AND METHODS:From September 2008 to March 2015, a total of 1990 gastric can...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-016-5667-4
更新日期:2017-04-01 00:00:00
abstract:BACKGROUND:Cholangiocarcinoma can be classified in intrahepatic cholangiocarcinoma (ICC) and perihilar cholangiocarcinoma (PCC). Moreover, PCC includes two different forms: extrahepatic (EH) PCC, which arises from the perihilar EH large ducts, and intrahepatic (IH) PCC, in which a significant liver mass invades the per...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-015-5046-6
更新日期:2016-05-01 00:00:00
abstract:BACKGROUND:The aim of this retrospective study was to investigate the incidence of mesenteric lymph node (MLN) involvement, and its prognostic role in advanced ovarian cancer (OC). METHODS:OC patients undergoing rectosigmoid resection during primary debulking surgery or interval debulking surgery were recorded. Progre...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3558-0
更新日期:2014-07-01 00:00:00
abstract:BACKGROUND:Most cytokine-based cancer gene therapy clinical trials have used labor-intensive, retrovirus-mediated strategies resulting in unpredictable gene expression. Recombinant AdV vectors were evaluated for easier, more reproducible gene transfer into 12 human melanoma, 2 murine fibrosarcomas, and 8 other tumor ce...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1007/BF02316813
更新日期:1997-01-01 00:00:00
abstract:BACKGROUND:Sarcopenia influences overall survival (OS) and tumor progression in non-small cell lung cancer (NSCLC) patients. However, the impact of postoperative complications and the outcome of limited surgery have not been highlighted. Therefore, the aim of this study is to elucidate the prognostic impact of sarcopen...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-020-08224-z
更新日期:2020-07-01 00:00:00
abstract:BACKGROUND:Locoregional therapy treatments for hepatic adenoma (HA) are typically limited to selective hepatic arterial embolization (HAE) to control acute hemorrhage. This systematic review sought to report the utilization of HAE and ablation for non-emergent treatment of HA. METHODS:A PubMed query identified studies...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-018-6802-1
更新日期:2019-01-01 00:00:00
abstract:BACKGROUND:Sentinel lymph node biopsy (SLNB) has been shown to reduce many of the long-term complications associated with a traditional axillary lymph node dissection (ALND); however, short-term outcomes have yet to be characterized. This study was designed to identify trends and differences in 30-day outcomes of parti...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-013-3248-3
更新日期:2014-01-01 00:00:00
abstract::Malignant tumors of epithelial tissue are the most common form of cancer and are responsible for the majority of cancer-related deaths in Western industrialized countries. As a result of progress in surgical treatment of these tumors, lethality is linked increasingly to early metastasis, which is generally occult at t...
journal_title:Annals of surgical oncology
pub_type: 杂志文章,评审
doi:
更新日期:2001-10-01 00:00:00
abstract:BACKGROUND:Currently, cytoreductive surgery and hyperthermic intraperitoneal chemotherapy are accepted treatments for surgically resectable appendiceal epithelial neoplasms. However, for nonsurgical candidates, systemic treatment may be considered. The purpose of this analysis was to determine the benefit of biologic t...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-4335-9
更新日期:2015-08-01 00:00:00
abstract:BACKGROUND:Angiotensin receptor blocker (ARB), a commonly used antihypertensive drug, is reported to affect wound healing and flap survival in animal models. However, this has not been elucidated in a clinical series. This study aimed to investigate the impact that perioperative use of ARB has on outcomes after breast ...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-019-07293-z
更新日期:2019-06-01 00:00:00
abstract:BACKGROUND:Definitive treatment of Graves' disease includes radioactive iodine (RAI) and thyroidectomy, but utilization varies. We hypothesize that, in addition to clinical reasons, there are socioeconomic factors that influence whether a patient undergoes thyroidectomy or RAI. METHODS:Patients treated for Graves' dis...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-4095-6
更新日期:2015-04-01 00:00:00
abstract:BACKGROUND:Whether breast cancer surgeons are adequately trained, skilled, and experienced to provide breast cancer genetic assessment, testing, and counseling came under debate in September 2013 when a major third-party payer excluded nongenetics specialists from ordering such testing. A literature search having faile...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-014-3711-9
更新日期:2014-12-01 00:00:00
abstract:PURPOSE:Recently, the American Joint Committee on Cancer (AJCC) 7th edition proposed new response criteria for neoadjuvant chemotherapy (NAC) in breast cancer. The purpose of this study was to evaluate the clinical usefulness of AJCC response criteria. METHODS:A total of 398 consecutive stage II or III breast cancer p...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-012-2756-x
更新日期:2013-07-01 00:00:00
abstract:BACKGROUND:This meta-analysis aimed to investigate the value of preoperative sarcopenia in predicting complications after esophagectomy. Clinicopathologic characteristics of sarcopenia patients, which may support sarcopenia management, also were studied. METHODS:This study searched for articles describing an associati...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-020-08236-9
更新日期:2020-08-01 00:00:00
abstract:PURPOSE:To prospectively determine the rate of malignancy after surgery in papillary lesions initially diagnosed at ultrasound (US)-guided 11-gauge vacuum-assisted breast biopsies. METHODS:Between May 2007 and December 2009, a total of 85 papillary lesions, including 73 benign papillomas and 12 atypical papillomas wer...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-011-1617-3
更新日期:2011-09-01 00:00:00
abstract:PURPOSE:Treatment of synovial sarcoma (SS) is challenging because of its unpredictable clinical behavior. We reviewed our institutional experience with pediatric SS to identify prognostic indicators and survival outcomes. METHODS:We retrospectively reviewed all pediatric/adolescent patients (age<22 years) with confirm...
journal_title:Annals of surgical oncology
pub_type: 杂志文章
doi:10.1245/s10434-012-2587-9
更新日期:2013-01-01 00:00:00