TY - JOUR
T1 - Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival?
T2 - Results from an international multicentre study
AU - Russell, Thomas B
AU - Labib, Peter L
AU - Denson, Jemimah
AU - Ausania, Fabio
AU - Pando, Elizabeth
AU - Roberts, Keith J
AU - Kausar, Ambareen
AU - Mavroeidis, Vasileios K
AU - Marangoni, Gabriele
AU - Thomasset, Sarah C
AU - Frampton, Adam E
AU - Lykoudis, Pavlos
AU - Maglione, Manuel
AU - Alhaboob, Nassir
AU - Bari, Hassaan
AU - Smith, Andrew M
AU - Spalding, Duncan
AU - Srinivasan, Parthi
AU - Davidson, Brian R
AU - Bhogal, Ricky H
AU - Croagh, Daniel
AU - Rajagopalan, Ashray
AU - Dominguez, Ismael
AU - Thakkar, Rohan
AU - Gomez, Dhanny
AU - Silva, Michael A
AU - Lapolla, Pierfrancesco
AU - Mingoli, Andrea
AU - Porcu, Alberto
AU - Perra, Teresa
AU - Shah, Nehal S
AU - Hamady, Zaed Z R
AU - Al-Sarrieh, Bilal
AU - Serrablo, Alejandro
AU - Aroori, Somaiah
N1 - Publisher Copyright:
© The Korean Association of Hepato-Biliary-Pancreatic Surgery.
PY - 2023/11/30
Y1 - 2023/11/30
N2 - 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-to-death (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.
AB - 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-to-death (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.
KW - Endoscopic retrograde cholangiopancreatography
KW - Magnetic resonance imaging
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - X-ray computed tomography
KW - Endoscopic retrograde cholangiopancreatography
KW - Magnetic resonance imaging
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - X-ray computed tomography
KW - Endoscopic retrograde cholangiopancreatography
KW - Magnetic resonance imaging
KW - Pancreatic ductal carcinoma
KW - Pancreaticoduodenectomy
KW - X-ray computed tomography
UR - https://portalrecerca.uab.cat/en/publications/3fec2284-6f14-413b-9a80-1e97a7775ab9
UR - https://www.mendeley.com/catalogue/8637b236-a9fe-3806-92fd-135bc132406b/
UR - http://www.scopus.com/inward/record.url?scp=85178358016&partnerID=8YFLogxK
U2 - 10.14701/ahbps.23-042
DO - 10.14701/ahbps.23-042
M3 - Article
C2 - 37661767
SN - 2508-5778
VL - 27
SP - 403
EP - 414
JO - Annals of Hepato-Biliary-Pancreatic Surgery
JF - Annals of Hepato-Biliary-Pancreatic Surgery
IS - 4
ER -