Has the Non-Resection Rate Decreased During the Last Two Decades among Patients Undergoing Surgical Exploration for Pancreatic Adenocarcinoma?

Abstract

Purpose: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC).Methods: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000–March 2011) and period #2 (April 2011–August 2019). Results: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P<.01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P<.01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (24% vs 25%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, PALNs invasion rate (0.4% vs 4.6%; P<0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9mm vs 6.4mm (P<.01), respectively) when the resection was not done. In multivariate analysis, CA 19-9<500U/mL (P<.01), and liver DW-MRI prescription (P<.01) favoured the resection. Conclusions: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

Time to Surgery Does Not Influence Survival Outcome in Patients With Upfront Resected Pancreatic Adenocarcinoma

“…No link was observed for stula, hemorrhage, or severe post-operative complications when TTS was shortened. Post pancreatectomy hemorrhage is mainly due to anastomotic leaks causing pseudoaneurysms (29). Also, when performed early, these interventions are less likely to be the subject of technical debate in multidisciplinary surgical meetings and patients may be less well prepared (uncorrected coagulation, nutritional status, or jaundice).…”