ThTP1.4 Should surgical candidates with a pancreatic head malignancy undergo resection within twenty-eight days of staging or undergo a repeat scan prior to surgery?

Abstract

Abstract Aims Suitable patients with a suspected pancreatic head malignancy should undergo timely pancreatoduodenectomy (PD) as pancreatic cancer is aggressive and recurrence rates are high. This study aimed to compare the outcomes of patients who did and did not undergo PD within 28 days of staging. 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). Pancreatic ductal adenocarcinoma patients (PDAC) were included. Patients were excluded if: they had staging data missing, they underwent neoadjuvant chemo-/radiotherapy, or if radiological staging was performed for another malignancy. Results 595 patient were included; median time from staging computed tomography (CT) to PD was 32 days (IQR: 38). The groups were similar in terms of age, sex and radiological stage. A similar number of patients in each underwent preoperative magnetic resonance imaging, positron emission tomography-CT and/or endoscopic ultrasound (EUS). However, those who underwent delayed PD had more often undergone staging laparoscopy (13.6% vs 5.9%, p=0.002) or preoperative biliary stenting (PBS, 69.2% vs 45.6%, p<0.00001). This group also had higher rates of histological T3 disease (85.4% vs 72.5%, p=0.0001) and R1 resection (57.8% vs 46.5%, p=0.01). Five-year recurrence/survival rates were similar. Conclusions Patients who underwent delayed PD had more often undergone staging laparoscopy or PBS. These investigations/interventions should only be performed when necessary. Although those with a delayed CT were more likely to have at least one positive resection margin, five-year outcomes were similar.