Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study
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 th...
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Published in | Annals of hepato-biliary-pancreatic surgery Vol. 27; no. 4; pp. 403 - 414 |
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Main Authors | , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , , |
Format | Journal Article |
Language | English |
Published |
Korea (South)
한국간담췌외과학회
30.11.2023
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Subjects | |
Online Access | Get full text |
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Summary: | 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.
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).
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%,
= 0.6), five-year survival (23% vs. 21%,
= 0.6) and median time-todeath (17 vs. 18 months,
= 0.8). Staging laparoscopy (43 vs. 29.5 days,
= 0.009) and preoperative biliary stenting (39 vs. 20 days,
< 0.001) were associated with a delay to PD, but magnetic resonance imaging (32 vs. 32 days,
= 0.5), positron emission tomography (40 vs. 31 days,
> 0.99) and endoscopic ultrasonography (28 vs. 32 days,
> 0.99) were not.
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. |
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Bibliography: | ObjectType-Article-1 SourceType-Scholarly Journals-1 ObjectType-Feature-2 content type line 23 |
ISSN: | 2508-5778 2508-5859 |
DOI: | 10.14701/ahbps.23-042 |