FTP7.13 Do additional preoperative investigations delay the time to resection in patients with pancreatic cancer? Results from the Recurrence After Whipple’s (RAW) study

Abstract

Abstract Aims Suitable patients with a resectable pancreatic cancer should undergo timely pancreatoduodenectomy (PD) as the disease is aggressive and recurrence rates are high. This study aimed to investigate whether selected preoperative investigations resulted in a delay to surgery. Methods Data were extracted from the Recurrence After Whipple’s (RAW) study, a retrospective study of PD outcomes (29 centres from eight countries, n=1484). Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy. The median time from radiological staging to PD was calculated in patients who underwent selected preoperative investigations and compared to those who did not undergo the investigation. Results In the 595 included patients, the median time from (most recent) preoperative computed tomography (CT) to PD was 32 days (IQR: 32) and 25%, 5%, 34%, 10% and 60% underwent preoperative magnetic resonance imaging (MRI), positron emission tomography (PET)-CT, endoscopic ultrasound (EUS), staging laparoscopy and/or biliary stenting (PBS), respectively. MRI (32 vs 31 days, p=0.55), PET-CT (40 vs 31 days, p=0.08) and EUS (28 vs 32 days, p=0.99) were not associated with an increased median time to PD. However, staging laparoscopy (43 vs 29.5 days, p=0.009) and PBS (39 vs 20 days, p<0.0001) were. Conclusions In our multicentre study of PD outcomes, preoperative MRI, PET-CT and EUS did not delay the time to resection. However, staging laparoscopy (median difference: 13.5 days) and PBS (median difference: 19 days) did, so these investigations/interventions should only be performed when there is a strong indication.