Effect of waiting time to surgery on pancreatic cancer survival: A nationwide population-based cohort study

Abstract

Background: Because of the aggressive nature of pancreatic cancer, timely surgery is considered to be important. However, little is known on the actual impact of waiting time to surgery on survival in pancreatic cancer patients. Materials & Methods: A nationwide population-based cohort study of all patients undergoing surgery for pancreatic cancer (resection or a palliative procedure) registered in the Danish Pancreatic Cancer Database during May 2011 to May 2016. We defined waiting time to surgery in two ways: 1) from the date of entry into the National Cancer Pathway to the date of surgery and 2) from the date of the last preoperative computed tomography (CT) or positron emission tomography (PET-CT) scan to the date of surgery. Waiting time was grouped into three groups: <28 days (<4 weeks), 28-55 days (4-8 weeks), and ≥56 days (≥8 weeks). We calculated median survival with associated 95% confidence intervals (CIs) for patients undergoing resection and for patients undergoing a palliative procedure. Results: We included 873 patients. Mean age was 67 years (range: 35-86 years). Resection was performed in 701 patients (80%); the remaining 172 patients (20%) underwent an explorative laparotomy or palliative surgery. 652 patients (75%) had a registration in the National Cancer Pathway (median waiting time: 31 days, and 818 patients (94%) had a registration of a preoperative CT or PET-CT scan (median waiting time: 32 days). We saw similar resection rates (∼80%) and median survival (∼22 months) in all thee groups. Conclusion: Waiting time to surgery did not affect survival in patients undergoing surgery for pancreatic cancer. Tabled 1Caption 1: Resection and survival rates following pancreatic cancer surgery according to pre-surgical waiting time.