O149 The utility of chest computed tomography in the staging of pancreatic cancer: a retrospective observational study

Abstract

Abstract Background Almost 50% of patients with pancreatic cancer initially present with metastatic disease. Current NICE guidelines recommend chest, abdomen and pelvis computed tomography (CT) for all patients with a diagnosis of pancreatic cancer. This study aimed to determine the incidence of lung metastases and the clinical utility of completion chest CT in this group. Methods Electronic healthcare records were retrospective reviewed at a regional hepatopancreaticobiliary centre to identify patients diagnosed with pancreatic cancer between 2010-2019 inclusive. Patient demographics, tumour characteristics, metastatic pattern and management outcomes such as surgery and chemotherapy were assessed for all patients. Kaplan Meier survival analysis were used to assess survival outcomes stratified by pattern of metastatic disease and treatment strategy. Results Of the 1293 patients who met the inclusion criteria 69.1%(n=863) had metastatic disease at diagnosis. Only 2.6% (32/1293) of the entire cohort presented with lung-only metastasis, with the liver being the commonest site of metastases (17.7%, 221/1293). Detection of lung metastases in the absence of intra-abdominal metastatic disease precluded surgery. However, lung metastases synchronous with intra-abdominal metastases did not alter management – chemotherapy or best supportive care. Patients with isolated lung metastasis had marginally improved median (IQR) survival [134 (48-347 days] compared with isolated liver [88 (36-221) days] and synchronous lung and liver metastases [88 (29-185) days, p<0.0001]. Conclusion For potential surgical candidates, a chest CT would be recommended as detection of lung metastasis would alter management. However, for patients with unresectable disease, a chest CT confers no additional benefit as management strategy would remain unchanged.