Annals of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회지)

The Korean Association of Hepato-Biliary-Pancreatic Surgery (한국간담췌외과학회)
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Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study

  • Thomas B. Russell (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Peter L. Labib (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Jemimah Denson (Department of HPB Surgery, University Hospitals Plymouth NHS Trust) ;
  • Fabio Ausania (Department of HPB Surgery, Hospital Clinic de Barcelona) ;
  • Elizabeth Pando (Department of HPB Surgery, Hospital Universitari Vall d'Hebron) ;
  • Keith J. Roberts (Department of HPB Surgery, University Hospitals Birmingham NHS Foundation Trust) ;
  • Ambareen Kausar (Department of HPB Surgery, East Lancashire Hospitals NHS Trust) ;
  • Vasileios K. Mavroeidis (Department of HPB Surgery, University Hospitals Bristol NHS Foundation Trust) ;
  • Gabriele Marangoni (Department of HPB Surgery, University Hospital Coventry & Warwickshire) ;
  • Sarah C. Thomasset (Department of HPB Surgery, NHS Lothian) ;
  • Adam E. Frampton (Department of HPB Surgery, Royal Surrey NHS Foundation Trust) ;
  • Pavlos Lykoudis (Department of HPB Surgery, Hull University Teaching Hospitals NHS Trust) ;
  • Manuel Maglione (Department of HPB Surgery, Medical University of Innsbruck) ;
  • Nassir Alhaboob (Department of HPB Surgery, Ibn Sina Specialized Hospital) ;
  • Hassaan Bari (Department of HPB Surgery, Shaukat Khanum Memorial Cancer Hospital) ;
  • Andrew M. Smith (Department of HPB Surgery, Leeds Teaching Hospitals NHS Trust) ;
  • Duncan Spalding (Department of HPB Surgery, Imperial College Healthcare NHS Trust) ;
  • Parthi Srinivasan (Department of HPB Surgery, King's College Hospital NHS Foundation Trust) ;
  • Brian R. Davidson (Department of HPB Surgery, Royal Free London NHS Foundation Trust) ;
  • Ricky H. Bhogal (Department of HPB Surgery, The Royal Marsden NHS Foundation Trust) ;
  • Daniel Croagh (Department of HPB Surgery, Monash Medical Centre) ;
  • Ashray Rajagopalan (Department of HPB Surgery, Monash Medical Centre) ;
  • Ismael Dominguez (Department of HPB Surgery, Salvador Zubiran National Institute of Health Sciences and Nutrition) ;
  • Rohan Thakkar (Department of HPB Surgery, Newcastle upon Tyne Hospitals NHS Foundation Trust) ;
  • Dhanny Gomez (Department of HPB Surgery, Nottingham University Hospitals NHS Trust) ;
  • Michael A. Silva (Department of HPB Surgery, Oxford University Hospitals NHS Foundation Trust) ;
  • Pierfrancesco Lapolla (Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza) ;
  • Andrea Mingoli (Department of HPB Surgery, Policlinico Umberto I University Hospital Sapienza) ;
  • Alberto Porcu (Department of HPB Surgery, Azienda Ospedaliero Universitaria di Sassari) ;
  • Teresa Perra (Department of HPB Surgery, Azienda Ospedaliero Universitaria di Sassari) ;
  • Nehal S. Shah (Department of HPB Surgery, Sheffield Teaching Hospitals NHS Foundation Trust) ;
  • Zaed Z. R. Hamady (Department of HPB Surgery, University Hospital Southampton NHS Foundation Trust) ;
  • Bilal Al-Sarrieh (Department of HPB Surgery, Swansea Bay University Health Board) ;
  • Alejandro Serrablo (Department of HPB Surgery, Hospital Universitario Miguel Servet) ;
  • Somaiah Aroori (Department of HPB Surgery, University Hospitals Plymouth NHS Trust)
  • Received : 2023.03.22
  • Accepted : 2023.06.06
  • Published : 2023.11.30
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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-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.

Keywords

Acknowledgement

We would like to thank all those involved in the RAW study.

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