Surgical Second Opinion for Pancreatic Cancer Patients

Abstract

Background: Due to the complexity of pancreatic surgery, patients diagnosed with pancreatic ductal adenocarcinoma (PDAC) may seek out the opinion of more than 1 surgeon. Little is known regarding how second surgical opinions impact the likelihood of pancreatectomy and perioperative outcomes. Our study aimed to determine the impact of obtaining second surgical opinions on pancreatectomy rates and to assess its impact on surgical outcomes.

Study design: Patients who were diagnosed with PDAC between 2013 and 2020 were identified using 100% Medicare Inpatient and Outpatient Standard Analytic Files. Data collected included the number of surgeons consulted and geographic region. Receipt of pancreatectomy and perioperative outcomes were compared between patients who received only 1 and more than 1 surgical consultation.

Results: Of 116,072 patients diagnosed with PDAC, 10,640 (9.2%) underwent pancreatectomy. A total of 4,913 (4.2%) patients received a second surgical opinion, of whom 1,906 (17.9%) patients underwent pancreatectomy after the second opinion visit. Patients receiving a second surgical opinion were more likely to undergo pancreatectomy (adjusted odds ratio 6.17; 95% CI 5.78 to 6.59). Patients who received a second opinion and underwent surgery had equivalent length of stay and complication rates compared to those who underwent surgery without seeking a second opinion (both p > 0.05).

Conclusions: Among Medicare patients who underwent pancreatectomy for pancreatic cancer, approximately 1 in 7 patients received a second surgical opinion. Further research is needed to determine how patient motivations, referral patterns, disease characteristics, and treatments all interplay to affect clinical outcomes for patients undergoing pancreatectomy for PDAC.