Impact of delay between imaging and treatment in patients with potentially curable pancreatic cancer

Sanjeevi, Srinivas; Ivanics, Tommy; Lundell, Lars; Kartalis, Nikolaos; Andrén‐Sandberg, Åke; Blomberg, John; Chiaro, Marco Del; Ansorge, Christoph

doi:10.1002/bjs.10046

Cited by 77 publications

(77 citation statements)

References 31 publications

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“…Despite a decreasing trend in non-resection at surgical exploration, the magnitude is still worrying. Although a Swedish study 26 suggested that treatment delay was associated with a higher probability of finding unresectable disease, delay in the Netherlands seems relatively short (median 28 versus 42 days respectively) 27 . Furthermore, neoadjuvant treatment (such as FOLFIRINOX -folinic acid, fluoro uracil, irinotecan, oxaliplatin), which could hamper correct preoperative staging 28 , but also increases resection rates 29,30 , was essentially not used in the present study period.…”

Section: Discussionmentioning

confidence: 97%

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Geest

Lemmens

Hingh

et al. 2017

British Journal of Surgery

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Section: Discussionmentioning

confidence: 97%

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Geest

Lemmens

Hingh

et al. 2017

British Journal of Surgery

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“…One study demonstrated that the resection rate was significantly higher when the imaging-to-resection interval was 32 days or less, when compared to longer waiting times (87 versus 74%). 22 Another recent study described that the implementation of a fast track pathway without preoperative biliary drainage for periampullary malignancies leads to a significant reduction in time from index CT to surgery, when compared to those who had been stented before referral (16 versus 65 days). In this study, the resection rate of the group without preoperative biliary drainage was significantly higher, when compared to that of the not drained group (97 versus 75%).…”

Section: Discussionmentioning

confidence: 99%

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Looijen

Pranger

Jong

et al. 2018

Journal of Gastrointestinal Surgery

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Background This study aimed to evaluate the additional value of laparoscopic ultrasound (LUS) to staging laparoscopy (SL) for detecting occult liver metastases in patients with potentially resectable pancreatic head cancer. Methods A retrospective cohort study was performed including all patients who underwent SL and LUS between 2005 and 2016. LUS was performed during SL to detect liver metastases not found by preoperative imaging or visual inspection of the liver. Results Out of 197 patients, visual inspection during SL detected distant metastases in 29 (14.7%) patients. LUS was performed in 127 patients, revealing 3 additional liver metastases. The proportion of patients with unresectable disease after SL and negative LUS was 32.3%, which was similar to 36.6% of patients with unresectable disease after SL without LUS (difference 4.3%; 95% CI − 13-23%; P = 0.61). Sensitivity, specificity, and positive and negative predictive values of LUS to detect liver metastases were 30, 100, 100, and 94%, respectively. The proportion of patients with distant metastases diagnosed at SL significantly increased over time (P = 0.031). Conclusion The routine use of LUS during SL for patients with potentially resectable pancreatic head cancer cannot be recommended. Imaging should be repeated when significant delay occurs between index CT and the scheduled surgery.

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“…Other studies claimed however that a detrimental effect on the prognosis could be introduced if certain waiting time threshold was exceeded. For example, prolonged interval between diagnostic imaging and resection over 32 days for pancreatic cancer was associated with significantly increased risk of unexpected tumor progress as determined at laparotomy [21]. A recent population-based study [22] emphasized a significantly lower overall survival among patients with non-metastatic invasive breast cancer after 30 days waiting time for surgery (approximately 10% decreasing survival for every 30-day increment in waiting).…”

Section: Discussionmentioning

confidence: 99%

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study

et al. 2017

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BackgroundExcept for overall survival, whether or not waiting time for treatment could influences other domains of cancer patients’ overall well-being is to a large extent unknown. Therefore, we performed this study to determine the effect of waiting time for cancer treatment on the mental health of patients with esophageal or gastric cancer.MethodsBased on the Swedish National Quality Register for Esophageal and Gastric Cancers (NREV), we followed 7,080 patients diagnosed 2006–2012 from the time of treatment decision. Waiting time for treatment was defined as the interval between diagnosis and treatment decision, and was classified into quartiles. Mental disorders were identified by either clinical diagnosis through hospital visit or prescription of psychiatric medications. For patients without any mental disorder before treatment, the association between waiting time and subsequent onset of mental disorders was assessed by hazard ratios (HRs) with 95% confidence interval (CI), derived from multivariable-adjusted Cox model. For patients with a preexisting mental disorder, we compared the rate of psychiatric care by different waiting times, allowing for repeated events.ResultsAmong 4,120 patients without any preexisting mental disorder, lower risk of new onset mental disorders was noted for patients with longer waiting times, i.e. 18–29 days (HR 0.86; 95% CI 0.74-1.00) and 30–60 days (HR 0.79; 95% CI 0.67-0.93) as compared with 9–17 days. Among 2,312 patients with preexisting mental disorders, longer waiting time was associated with more frequent psychiatric hospital care during the first year after treatment (37.5% higher rate per quartile increase in waiting time; p for trend = 0.0002). However, no such association was observed beyond one year nor for the prescription of psychiatric medications.ConclusionsThese data suggest that waiting time to treatment for esophageal or gastric cancer may have different mental health consequences for patients depending on their past psychiatric vulnerabilities. Our study sheds further light on the complexity of waiting time management, and calls for a comprehensive strategy that takes into account different domains of patient well-being in addition to the overall survival.Electronic supplementary materialThe online version of this article (doi:10.1186/s12885-016-3013-7) contains supplementary material, which is available to authorized users.

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Impact of delay between imaging and treatment in patients with potentially curable pancreatic cancer

Abstract: Operation within 32 days of diagnostic imaging reduced the risk of tumour progression to unresectable disease by half compared with a longer waiting time. The results of this study highlight the importance of efficient clinical PDAC management.

Cited by 77 publications

References 31 publications

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Waiting time for cancer treatment and mental health among patients with newly diagnosed esophageal or gastric cancer: a nationwide cohort study

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