Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study
Author(s)
Type
Journal Article
Abstract
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.
Date Issued
2023-11-30
Date Acceptance
2023-06-06
Citation
Annals of Hepato-biliary-pancreatic Surgery, 2023, 27 (4), pp.403-414
ISSN
2508-5778
Publisher
Korean Association of Hepato-biliary-pancreatic Surgery
Start Page
403
End Page
414
Journal / Book Title
Annals of Hepato-biliary-pancreatic Surgery
Volume
27
Issue
4
Copyright Statement
© 2023 The Korean Association of Hepato-Biliary-Pancreatic Surgery. This is an Open Access article distributed under the terms of the Creative Commons Attribution Non-Commercial License (http://creativecommons.org/licenses/by-nc/4.0) which permits unrestricted non-commercial use, distribution, and reproduction in any medium, provided the original work is properly cited.
License URL
Identifier
https://www.ncbi.nlm.nih.gov/pubmed/37661767
PII: ahbps.23-042
Subjects
Endoscopic retrograde cholangiopancreatography
Magnetic resonance imaging
Pancreatic ductal carcinoma
Pancreaticoduodenectomy
X-ray computed tomography
Publication Status
Published
Coverage Spatial
Korea (South)
Date Publish Online
2023-11-30