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BackgroundPancreatic cancer surgery is increasingly regionalized in high‐volume centres. Provision of adjuvant chemotherapy in the same institution can place a burden on patients, whereas receiving adjuvant chemotherapy at a different institution closer to home may create disparities in care. This study compared long‐term outcomes of patients with pancreatic adenocarcinoma receiving adjuvant chemotherapy at the institution where they had undergone surgery with outcomes for those receiving chemotherapy at a different institution.MethodsThis was a population‐based study of patients receiving adjuvant chemotherapy after resection of pancreatic adenocarcinoma performed at ten designated hepatopancreatobiliary centres in Ontario, Canada, between 2004 and 2014. Patients were divided into those receiving chemotherapy at the same institution as surgery or a different institution from where surgery was performed. The primary outcome was overall survival (OS). Multivariable Cox regression assessed the association between OS and each chemotherapy group, adjusted for potential confounders.ResultsOf 589 patients, 374 (63·5 per cent) received adjuvant chemotherapy at the same institution as surgery. After adjusting for age, sex, co‐morbidity, socioeconomic status, rural living, tumour stage, margin positivity and year of surgery, the location of adjuvant chemotherapy was not independently associated with OS (hazard ratio 1·03, 95 per cent c.i. 0·85 to 1·24). For patients who underwent chemotherapy at a different institution, mean travel distance to receive chemotherapy was less (22·9 km) than that needed for surgery (106·7 km).ConclusionAfter pancreatectomy for pancreatic adenocarcinoma at specialized hepatopancreatobiliary surgery centres, OS was not affected by the location of the centre delivering adjuvant chemotherapy. Receiving this treatment in a local centre reduced patients' travel burden.

136 Background: Despite improvements in multidisciplinary care and surgical technique, ≈40% of patients recur after curative resection for GCa. Adjuvant treatment decisions should be informed by the expected timing and site of failure, but accurate data are limited. The aim of our study was to describe and analyze the patterns of recurrence at our center. Methods: Patients who underwent curative intent margin-negative resection from 2006-16 were identified from a prospective GCa database. Date of first detection and site of recurrence were determined. Survival curves were calculated by the KM method. Univariate and multivariable analyses (MVA) were performed to identify predictive variables. Significance was set at p < 0.05. Results: Of 123 patients who met inclusion criteria, median age was 70 yrs, 37% were female, and median follow-up after resection was 24 mos (IQR 11-40). Five-year OS was 72% and RFS 69%. In 34 of 36 patients who recurred, recurrence was detected within 2 yrs. Receipt of adjuvant therapy (Macdonald or MAGIC) was associated with better 5-year OS and RFS than surgery alone (79% vs. 60%, 77% vs. 60%) and delayed time to recurrence (median 10.4 vs. 7.1 mos). Receipt of CRT by the Macdonald protocol appeared to lower the risk of locoregional recurrence vs. surgery alone (see Table) despite routine D2 lymphadenectomy. On MVA, recurrence at any site was predicted by age £ 60y (OR 3.8), male gender (4.0), and AJCC stage > II (4.6). Peritoneal recurrence was predicted only by age £ 60y (3.2). Conclusions: Recurrence after curative resection occurred within 2 yrs of resection. Locoregional recurrence was uncommon in patients who received postoperative CRT. Peritoneal recurrence, which might be abrogated by prophylactic HIPEC at the time of resection, is not well explained by clinicopathologic variables, and novel molecular predictors are required. [Table: see text]