Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study

Journal article

Backgrounds/aims: pancreatoduodenectomy (PD) is recommended in fit patients with a carcinoma (PDAC) of the pancreatic head, and a delayed resection may affect survival. This study aimed to correlate the time from staging to PD with long-term survival, and study the impact of preoperative investigations (if any) on the timing of surgery.Methods: data were extracted from the Recurrence After Whipple's (RAW) study, a multicentre retrospective study of PD outcomes. Only PDAC patients who underwent an upfront resection were included. Patients who received neoadjuvant chemo-/radiotherapy were excluded. Group A (PD within 28 days of most recent preoperative computed tomography [CT]) was compared to group B (> 28 days).Results: a total of 595 patents were included. Compared to group A (median CT-PD time: 12.5 days, interquartile range: 6-21), group B (49 days, 39-64.5) had similar one-year survival (73% vs. 75%, p = 0.6), five-year survival (23% vs. 21%, p = 0.6) and median time-todeath (17 vs. 18 months, p = 0.8). Staging laparoscopy (43 vs. 29.5 days, p = 0.009) and preoperative biliary stenting (39 vs. 20 days, p < 0.001) were associated with a delay to PD, but magnetic resonance imaging (32 vs. 32 days, p = 0.5), positron emission tomography (40 vs. 31 days, p > 0.99) and endoscopic ultrasonography (28 vs. 32 days, p > 0.99) were not.Conclusions: although a treatment delay may give rise to patient anxiety, our findings would suggest this does not correlate with worse survival. A delay may be necessary to obtain further information and minimize the number of PD patients diagnosed with early disease recurrence.

Authors: Russell, TB; Labib, PL; Denson, J; Ausania, F; Pando, E

• Publication status: Published
• Peer review status: Peer reviewed
• Publisher: The Korean Association of Hepato-Biliary-Pancreatic Surgery
• Journal: Annals of Hepato-Biliary-Pancreatic Surgery
• Volume: 27
• Issue: 4
• Pages: 403-414
• Publication date: 2023-09-04
• DOI: 10.14701/ahbps.23-042
• ISSN: 2508-5778
• Language: English
• Keywords: Surgery; Interquartile range; Cancer; Pancreatic cancer; Medicine; Internal medicine; Radiation therapy; Retrospective cohort study