the impact of hospital neoadjuvant therapy utilization on survival outcomes for pancreatic cancer background many surgeons advocate the use of neoadjuvant treatment for resectable pancreatic cancer however little is known about variation in the utilization of neoadjuvant therapy nat at the hospital levelmethods the national cancer data base was used to identify patients undergoing resection for pancreatic cancer between 2006 and 2014 at highvolume centers hospitals were grouped by nat utilization using standard deviations sd from the mean as follows high neoadjuvant utilizers 2 sds above the mean40 of patients receiving nat mediumhigh 12 sds 2740 medium 01 sd 1426 or low 11 to 0 sds40 of patients these five hospitals had the longest median os at 289 months compared with 211 months for low neoadjuvant utilizers p0001 on multivariable analysis high and mediumhigh nat utilization predicted improved os with a hazard ratio hr of 068 95 confidence interval ci 056083 p0001 and 080 95 ci 068095 p0010 respectively compared with low utilizers after excluding patients who underwent nat there remained an association of improved os with high nat utilization hr 074 95 ci 060093 p0009conclusion highvolume hospitals that more commonly utilize nat demonstrated longer survival for all patients treated at those centers in addition to altering patient selection for surgery high neoadjuvant utilization may be a marker of institutional factors that contribute to improved outcomes