학술논문
Does an extensive diagnostic workup for upfront resectable pancreatic cancer result in a delay which affects survival? Results from an international multicentre study
Document Type
Academic Journal
Author
Thomas B. Russel; 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; RAW Study Collaborators; Somaiah Aroori
Source
Annals of Hepato-Biliary-Pancreatic Surgery. 2023-11 27(4):403-414
Subject
Language
Korean
ISSN
2508-5778
2508-5859
2508-5859
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.