Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis

Müller, Philip C.; Hodson, James; Kuemmerli, Christoph; Kalisvaart, Marit; Pandé, Rupaly; Roberts, Keith

doi:10.1007/s00423-020-01893-0

Cited by 10 publications

(11 citation statements)

References 30 publications

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“…However, a recent multicenter study including 312 subjects reported higher morbidity, biliary fistulae, and hospital length of stay if surgery is performed within 4 weeks of PBD 87 and delaying surgery did not translate in greater morbidity or major complications in another study 88 . A meta‐analysis of 21 studies comprising 2171 patients found earlier surgery to be significantly associated with higher resection rates 89 …”

Section: Duration Of Drainage Prior To Surgical Resectionmentioning

confidence: 98%

“…88 A meta-analysis of 21 studies comprising 2171 patients found earlier surgery to be significantly associated with higher resection rates. 89 The results of these studies remain subject to bias given their retrospective design and further prospective trials are needed to assess whether the shorter drainage period and lower complication rate would outweigh the shorter recovery period of the liver function. In routine practice, time to surgery after PBD is affected by several factors including NAT, cholangitis, and patient related factors such as malnutrition and comorbidities.…”

Section: Duration Of Drainage Prior To Surgical Resectionmentioning

confidence: 99%

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Preoperative biliary drainage for pancreatic cancer

Nehme

Lee

2021

Digestive Endoscopy

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Pancreatic adenocarcinoma is currently one of the leading causes of cancer-related morbidity and mortality with dismal long term survival after diagnosis. Nearly 85% of pancreatic cancer patients present with advanced disease precluding curative surgical resection. In those who are candidates for surgery, preoperative biliary drainage (PBD) has been developed since the 1960s in order to improve surgical outcomes. While obstructive jaundice in resectable pancreatic cancer has been traditionally treated before surgical resection in all patients, data over the past decade demonstrated increased perioperative complications and morbidity with systematic PBD compared to direct surgery. With new evidence of potential adverse events, the role of routine PBD is being reassessed. Current indications for PBD include cholangitis, delayed surgery, and relief of jaundice in patients planned to receive neoadjuvant therapy (NAT). NAT is being increasingly utilized in borderline resectable as well as resectable pancreatic cancer and a higher proportion of patients with likely require PBD in the future. The evidence for endoscopic retrograde cholangiopancreatography as first line for PBD is robust with supporting data from endoscopic ultrasound assisted biliary drainage. Selfexpanding metal stent was shown to be cost-effective in recent studies without increase in morbidity compared to plastic stents in this setting. In this review, we will summarize the current evidence for PBD in patients with pancreatic cancer.

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Section: Duration Of Drainage Prior To Surgical Resectionmentioning

confidence: 98%

Section: Duration Of Drainage Prior To Surgical Resectionmentioning

confidence: 99%

Preoperative biliary drainage for pancreatic cancer

Nehme

Lee

2021

Digestive Endoscopy

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“…Despite a detrimental effect of the waiting list elongation on survival has never been clearly demonstrated for pancreatic cancer, it is well known that the clinical progression from low-stage to advanced-stage disease is rapid in this disease. Moreover, reducing the time to surgery seems to affect the increase in cancer size and the rates of radical resections [ 20 – 22 ].…”

Section: Discussionmentioning

confidence: 99%

Pancreatic surgery during COVID-19 pandemic: major activity disruption of a third-level referral center during 2020

Marchegiani¹,

Perri²,

Bianchi³

et al. 2021

Updates Surg

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Introduction The COVID-19 pandemic has severely limited the access to cancer surgery, but it is not known to what extent referral centers for pancreatic diseases were affected by its outbreak. The aim of this study is to describe the effect of COVID-19 pandemic on a third-level referral center for pancreatic surgery in Italy. Methods The 2020 activity of The Pancreas Institute of the University of Verona was reviewed, comparing different phases of the COVID-19 pandemic outbreaks using the pre-COVID era as a control. Endpoints were the overall caseload of pancreatic resections, surgical waiting list, administration of preoperative therapy, major morbidity and mortality, residents’ training; number of inpatients beds, outpatient visits/procedures/diagnostics. Results In 2020, there was an overall significant reduction of pancreatic resections performed (394 vs. 506 in 2019), particularly during the first (March–May) and second (October–December) COVID-19 outbreaks, with an all-time-low of 16 resections/months in April (compared to 43 average resection/month in 2019). The rates of major morbidity (Clavien–Dindo ≥ 3) and mortality were similar to 2019 (16 vs 12%, p = 0.11 and 3 vs 2%, p = 0.29, respectively). During the first and second outbreaks resident’s training, inpatient beds, outpatient visits, diagnostics, and procedures were severely impaired, while the waiting list for up-front cancer resections and the use of preoperative chemotherapy concomitantly raised. Conclusion The COVID-19 pandemic has severely disrupted the activity of a third-level referral center for pancreatic surgery, affecting the access to cancer surgical procedures and raising concerns regarding the solidity of the current centralization model. Supplementary Information The online version contains supplementary material available at 10.1007/s13304-021-01197-y.

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“…Traditionally, surgical resection of primary pancreatic tumours without vessel involvement is the treatment of choice in eligible patients ( 21 ) and is recommended by national and international guidelines ( 22 ). Moreover, “fast-track” clinical pathways can facilitate prompt patient access to surgery and result in higher resection rates and improved outcomes ( 23 ). Although postoperative complications can delay the administration of systemic treatment ( 24 , 25 ), recent advancements in chemotherapy ( 6 , 7 ) have had a significant impact in recurrence-free and overall survival rates ( 26 ).…”

Section: Discussionmentioning

confidence: 99%

Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice

et al. 2021

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BackgroundIt is presently unclear what clinical pathways are followed for patients with non-metastatic PDAC in specialised centres for pancreatic surgery across the United Kingdom (UK).MethodsBetween August 2019 and August 2020 an electronic survey was conducted aiming at a national cohort of pancreatic surgeons in the UK. Participants replied to a list of standardised questions and clinical vignettes, and data were collected and analysed focusing on management preferences, resectability criteria, and contraindications to surgery.ResultsWithin the study period, 65 pancreatic surgeons from 27 specialist centres in the UK (96%) completed the survey. Multidisciplinary team meetings are utilised universally for the management of patients with PDAC, however, different staging systems for resectability classification are being applied. In borderline resectable PDAC, most surgeons were keen to proceed with surgical exploration post NAT, but differences were noted in preferred chemotherapy regimens. Surgeons from standard volume institutions performed fewer vein resections annually and were more likely to deem patients with locally advanced PDAC as unresectable. Intra-institutional variability in patient management was also present and ranging between 20-80%.ConclusionsSignificant variability in the surgical management of non-metastatic PDAC was identified both on inter- and intra-institutional level.

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Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis

Cited by 10 publications

References 30 publications

Preoperative biliary drainage for pancreatic cancer

Preoperative biliary drainage for pancreatic cancer

Pancreatic surgery during COVID-19 pandemic: major activity disruption of a third-level referral center during 2020

Surgical Management of Non-Metastatic Pancreatic Cancer in the United Kingdom: Results of a Nationwide Survey on Current Practice

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