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

• Published in: Annals of hepato-biliary-pancreatic surgery 2023, Vol.27 (4), p.403-414
• Main Authors: Thomas B. Russell, Peter L. Labib, Jemimah Denson, Fabio Ausania, Elizabeth Pando, Keith J. Roberts, Ambareen Kausar, Vasileios K. Mavroeidis, Gabriele Marangoni, Sarah C. Thomasset, Adam E. Frampton, Pavlos Lykoudis, Manuel Maglione, Nassir Alhaboob, Hassaan Bari, Andrew M. Smith, Duncan Spalding, Parthi Srinivasan, Brian R. Davidson, Ricky H. Bhogal, Daniel Croagh, Ashray Rajagopalan, Ismael Dominguez, Rohan Thakkar, Dhanny Gomez, Michael A. Silva, Pierfrancesco Lapolla, Andrea Mingoli, Alberto Porcu, Teresa Perra, Nehal S. Shah, Zaed Z. R. Hamady, Bilal Al-Sarrieh, Alejandro Serrablo, Somaiah Aroori
• Format: Article
• Language: Korean
• ISSN: 2508-5778; 2508-5859

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.