Time from first seen in specialist care to surgery does not influence survival outcome in patients with upfront resected pancreatic adenocarcinoma

Abstract

Background This study evaluated the impact of time to surgery (TTS) on overall survival (OS), disease free survival (DFS) and postoperative complication rate in patients with upfront resected pancreatic adenocarcinoma (PA). Methods We retrospectively included patients who underwent upfront surgery for PA between January 1, 2004 and December 31, 2014 from four French centers. TTS was defined as the number of days between the date of the first consultation in specialist care and the date of surgery. DFS for a 14-day TTS was the primary endpoint. We also analyzed survival depending on different delay cut-offs (7, 14, 28, 60 and 75 days). Results A total of 168 patients were included. 59 patients (35%) underwent an upfront surgery within 14 days. Patients in the higher delay group (> 14 days) had significantly more vein resections and endoscopic biliary drainage. Adjusted OS (p = 0.44), DFS (p = 0.99), fistulas (p = 0.41), hemorrhage (p = 0.59) and severe post-operative complications (p = 0.82) were not different according to TTS (> 14 days). Other delay cut-offs had no impact on OS or DFS. Discussion TTS seems to have no impact on OS, DFS and 90-day postoperative morbidity.

Structural and Socio-Spatial Determinants Influencing Care and Survival of Patients with a Pancreatic Adenocarcinoma: Results of the PANDAURA Cohort

“…However, Sanjeevi et al observed that a delay between the first imaging and resection > 32 days was associated with an increased risk of progress from resectable to unresectable in the univariate analysis without significance after multivariate in 349 patients [ 7 ]. In a series of 168 patients treated with upfront surgery for localized PDAC, Brugel et al found that the delay between the first specialist consultation and surgery had no significant impact on DFS, OS, or 90-day morbidity [ 6 ]. Based on these studies, tumor size and degree of local involvement seem to be the strongest factors associated with survival, even though surgical retrospective series are biased.…”

“…The common sense hypothesizing that an early recognition and a short delay before starting an appropriate treatment should theoretically lead to a better prognosis in PDAC has been intuitively accepted as true. However, to what extent waiting times and, in particular, the diagnosis delay, have an impact on the OS of PDAC patients remains controversial due to opposite results in the literature [ 5 , 6 , 7 ]. Moreover, the idea that multiple factors such as socio-spatial inequalities in delay and in quality of care may interfere with cancer treatment and prognosis is growing in the literature [ 8 ].…”