PancreasAssociation of time-to-surgery with outcomes in clinical stage I-II pancreatic adenocarcinoma treated with upfront surgery
Section snippets
Methods
The data source for this study is the NCDB, a hospital-based registry jointly managed by the Commission on Cancer (CoC) and the American Cancer Society. The NCDB includes >1,500 CoC-accredited hospitals, and it captures >70% of new cancer diagnoses in the United States.15 The University of Utah Institutional Review Board considered this study exempt from review.
The study population was adults with clinical stage I to II PDAC that underwent curative-intent surgery without neoadjuvant therapy.
Sensitivity Analyses
Sensitivity analyses were conducted to verify the robustness of the assumptions and findings of the primary analysis. Covariates of patients excluded for diagnosis at surgery (TTS 0 days) were compared to the primary analysis cohort (TTS 1–120 days) because values of 0 days of TTS were handled as a form of missing data. Multivariable models for primary and secondary outcomes were repeated including patients diagnosed at surgery. Multivariable survival analyses were repeated with OS defined as
Results
Of 16,763 patients, 5,774 (34.4%) had short TTS, 8,650 (51.6%) had medium TTS, and 2,339 (14.0%) had long TTS. Covariates stratified by TTS groups are shown in Table 1. More patients in the short TTS group were young, privately insured, without comorbidities or cancer history, had undocumented clinical stage, had pancreatic head tumors, were seen at only one CoC hospital, and traveled a short distance compared to medium TTS. More long TTS patients were elderly, Medicare insured, had
Discussion
Patients and physicians often assume that time is of the essence with regard to surgical wait times in PDAC because it is such an aggressive disease. In this observational analysis of patients with clinical stage I to II PDAC that underwent upfront curative-intent surgery, TTS ≤2 weeks was associated with slightly shorter OS and higher perioperative mortality. Furthermore, patients with medium and long TTS did not have higher odds of secondary outcomes selected to act as surrogates for tumor
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Cited by (16)
The impact of surgery delay on survival of resectable pancreatic cancer: A systematic review of observational studies
2022, Surgical OncologyCitation Excerpt :A similar diversity was, also, observed in the terms of the impact of the waiting time interval on survival outcomes (Table 3). In particular, a prolonged waiting time interval was associated with decreased overall survival in 3 studies [24,25,30], whereas it demonstrated a favorable effect on overall survival in 2 studies [28,29] and no impact on survival in 5 studies [21–23,26,27]. However, surgery time delay seemed to be associated with increased unresectability rates [26], increased histopathological disease progression compared to clinical staging [22], increased tumor size [24] and increased vein resections during surgery [21].
Strategy for the practice of digestive and oncological surgery during the Covid-19 epidemic
2020, Journal of Visceral SurgeryImpact of surgical wait times on oncologic outcomes in resectable pancreas adenocarcinoma
2020, HPBCitation Excerpt :Similarly, a retrospective study by Rapitis et al. found no significant difference in survival with increased wait time to either systemic therapy for the unresectable disease or surgery for resectable patients.17 The most recently published study by Swords et al. examined the same patient population as our study using a hospital-based registry as a part of a National Cancer Database.18 The authors found that patients had a better survival as wait time increased, concluding that a selection bias of only patients who made it to surgery was likely contributing to their results.
ESMO Management and treatment adapted recommendations in the COVID-19 era: Pancreatic Cancer
2020, ESMO OpenCitation Excerpt :Data are lacking, but a registry analysis on 16 673 patients affected by pancreatic cancer in stage I-II showed that a medium time to surgery of 15–42 days does not correlate with worse survival. A delay up to 3 months could select patients with a less aggressive cancer biology and allow a preoperative medical optimisation of patient comorbidities before elective surgery.19 Nevertheless, the immune-depressive but potentially curative pancreatic cancer resection still retains a high priority to be evaluated in a multidisciplinary team consultation, discussing available resources in the pandemic, life expectations, and complications associated with an eventual SARS-CoV-2 infection.
Commentary: Take your time but quickly! Impact of time to surgery in early esophageal cancer
2020, Journal of Thoracic and Cardiovascular Surgery
Supported by the University of Utah Study Design and Biostatistics Center, with funding in part from the National Center for Research Resources and the National Center for Advancing Translational Sciences, National Institutes of Health, through grant 5UL1TR001067-02 (formerly 8UL1TR000105 and UL1RR025764).
Presented as an oral presentation at the 12th Annual Academic Surgical Congress in Las Vegas, NV, February 8, 2017.
National Cancer Database Acknowledgement: The data used in the study are derived from a de-identified NCDB file. The American College of Surgeons and the Commission on Cancer have not verified and are not responsible for the analytic or statistical methodology used, or the conclusions drawn from these data by the investigator.
Accepted for publication October 30, 2017.