Ann Hepatobiliary Pancreat Surg.  2018 Nov;22(4):405-411. 10.14701/ahbps.2018.22.4.405.

The survival impact of surgical waiting time in patients with resectable pancreatic head cancer

• Seo HK
• Hwang DW
• Park SY
• Park Y
• Lee SJ
• Lee JH
• Song KB
• Lee YJ
• Kim SC

• KMID: 2427373
• DOI: http://doi.org/10.14701/ahbps.2018.22.4.405

Abstract

BACKGROUNDS/AIMS
After centralization policy, clinical outcomes have been improved in patients underwent pancreaticoduodenectomy for pancreatic cancer. However, centralization could exacerbate the prolongation of surgical waiting time. This study aims to investigate whether the shorter waiting time correlates with the better survival and to identify the major confounders that influence the association between those.
METHODS
In this retrospective cohort study, a total 554 patients with pathologically confirmed pancreatic ductal adenocarcinoma were assessed the eligibility from 2014 through 2015. Patients with neoadjuvant chemotherapy, body-tail resection, total pancreatectomy and combined adjacent organ resection were excluded. All patients were divided into two groups by median waiting time, 21 days, defined as the date difference between initial imaging diagnosis and operation.
RESULTS
Median overall survival did not differ between long and short waiting group (30.4 vs 24.8 months, p=0.35; HR=0.84, 95% CI=0.58-1.21). The proportion of cancer stage shifting, the difference between clinical and pathologic staging, did not differ depending on waiting time group (p=0.811 and 0.255, each of reviewers). Short waiting time was highly correlated with high initial clinical stage (Spearman correlation coefficients −0.201 (p=0.006) and −0.100 (p=0.175), each of reviewers).
CONCLUSIONS
Initial clinical stage had confounding effect on the association between waiting time and overall survival. Therefore, in evaluating centralization policy at the national level, evidence for maximum acceptable waiting time should be investigated in the near future with considering that surgical waiting time could be affected by initial clinical stage.

Keyword

Pancreatic cancer; Pancreaticoduodenectomy; Waiting time; Survival

MeSH Terms

Adenocarcinoma
Cohort Studies
Diagnosis
Drug Therapy
Head and Neck Neoplasms*
Head*
Humans
Pancreatectomy
Pancreatic Ducts
Pancreatic Neoplasms
Pancreaticoduodenectomy
Retrospective Studies

Figure

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  Fig. 1 Flow chart of study population. PDAC: Pancreatic ductal adenocarcinoma. *These were 13 patients who underwent combined resection including two or more adjacent organs.

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  Fig. 2 The Kaplan-Meier curves of the long- and short-waiting group stratified by preoperative waiting time. Wait=long if waiting time from diagnosis >21 days.

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  Fig. 3 The proportion of cancer stage shifting depending on waiting time.

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  Fig. 4 Analyses for the distribution of waiting time stratified by initial clinical stage and the correlation between those variables.

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