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Is it worth looking? Abdominal imaging after pancreatic cancer resection: a national study
Elan R Witkowski1, Jillian K Smith, Elizaveta Ragulin-Coyne
1Department of Surgery, Surgical Outcomes Analysis and Research, University of Massachusetts Medical School, 55 Lake Avenue North, S3-752, Worcester, MA 01655-0002, USA.
Introduction:
Abdominal imaging is often performed after pancreatic cancer resection. We attempted to quantify the volume and estimate the cost of complex imaging after pancreatectomy nationwide, and to determine whether their frequent use confers benefit.
Methods:
Patients with pancreatic adenocarcinoma who underwent resection were identified in Surveillance, Epidemiology and End Results-Medicare (1991-2005). Claims for abdominal imaging ≤5 years after resection were analyzed. Patients receiving annual CT scans were identified. Univariate and multivariate analyses were performed. To assess frequency of annual CT scanning in patients with superior survival, the top decile was further analyzed.
Results:
Eleven thousand eight hundred fifty studies were performed on 2,217 patients. Ten thousand five hundred forty-two (89%) were CT scans. The median number of scans doubled from three in 1991 to six in 2005 (p < 0.0001). Among patients with sufficient survival to allow for analysis, 51.3% received annual CT scans, while only 32.4% of top-performing patients received annual scans. Univariate analysis of the 10% of patients with superior survival did not reveal any significant benefit associated with annual imaging.
Conclusion:
Utilization of complex imaging after pancreatic cancer resection has increased substantially among Medicare beneficiaries, driven primarily by an increasing number of CT scans. Our study demonstrated no significant survival benefit among patients who received scans on a routine basis.