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had full access to all the data in the study and take responsibility for the integrity of the data and the accuracy of the data analysis.

Objectives: Aim of this study was to evaluate the impact of epidural analgesia on postoperative length of stay, expeditious discharge, and pain relief after pancreaticoduodenectomy and distal pancreatectomy.Methods: Retrospective reviews of 2014-2015 American College of Surgeons National Surgical Quality Improvement Program databases and our institutional pancreas surgery database were conducted.Results: On univariate analysis, epidural analgesia was associated with statistically significant longer lengths of stay for both pancreaticoduodenectomy and distal pancreatectomy. On comparative analysis at mode length of stay, discharged before vs. after 7 days for pancreaticoduodenectomy and 6 days for distal pancreatectomy, epidural analgesia was a significant predictor for the longer groups for both procedures on multivariable analysis (pancreaticoduodenectomy: odds ratio 1.465; P < 0.001, distal pancreatectomy: odds ratio 1.471; P = 0.004). On review of our institution's pancreas surgery database, patient-reported pain scores were significantly lower in the epidural analgesia groups than intravenous narcotics groups on the day of surgery only for both pancreaticoduodenectomy and distal pancreatectomy.Conclusions: Epidural analgesia was associated with longer length of stay with a most pronounced effect on early discharge after surgery for patients undergoing open pancreaticoduodenectomy and distal pancreatectomy. It only resulted in superior pain control on the day of surgery.

Background and objectives: The role of surgery in the treatment of nonfunctional pancreatic neuroendocrine carcinomas (PNEC) is not well defined. This study investigated the effect of surgical resection on cause-specific survival compared with nonoperative management.Methods: The Surveillance, Epidemiology, and End Results Program (SEER) database was utilized to identify patients with nonfunctional pancreatic neuroendocrine carcinoma diagnosed between January 1, 2004 and December 31, 2015. Survival was modeled using Kaplan-Meier analysis and multivariable Cox proportional hazards models.Results: Of the 488 patients identified, 137 (29%) underwent surgical resection of the primary site. Patients who underwent surgery had a median CSS of 31 months compared with 5 months in those who did not (p < 0.01). A survival benefit was observed when the cohort was stratified into local, nodal, and metastatic disease. Conclusion:Resection of the primary site in the cohort of PNEC patients compiled by SEER is associated with improved survival. Further consideration be placed on primary surgical resection for PNEC while additional studies that can select specifically for high-grade, poorly differentiated carcinomas need to be undertaken.

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