Survival Advantage of Upfront Surgery for Pancreatic Head Cancer Without Preoperative Biliary Drainage.
fast track surgery
intention to treat (ITT) analysis
pancreatic surgery
preoperative biliary drainage
survival
Journal
Frontiers in oncology
ISSN: 2234-943X
Titre abrégé: Front Oncol
Pays: Switzerland
ID NLM: 101568867
Informations de publication
Date de publication:
2020
2020
Historique:
received:
13
01
2020
accepted:
13
10
2020
entrez:
30
11
2020
pubmed:
1
12
2020
medline:
1
12
2020
Statut:
epublish
Résumé
Level 1 evidence from randomized trials demonstrates less complication when jaundiced patients with resectable pancreatic cancer proceed directly to surgery, rather than undergo preoperative biliary drainage (PBD) first. Although "fast track" surgery significantly increases the resectability rate, it is unknown whether this translates into a survival benefit. This study evaluated the effect of upfront surgery on long-term survival using an intention-to-treat (ITT) analysis. Patients were identified from a prospectively maintained database, stratified according to whether or not they underwent PBD. Among 157 patients, 84 (54%) underwent PBD. Of these, 73% underwent surgery, compared to 100% of those without PBD (p<0.001). Reasons for not undergoing surgery were progression of cancer (N=11), progressive frailty (N=5), or PBD-related complication (N=7). In those who underwent surgery, PBD was associated with a longer time from diagnosis to surgery (median: 59 vs. 14 days, p<0.001), and a higher rate of unresectable cancer at surgery (26% vs. 3%, p<0.001). On an ITT basis, patients treated with PBD had significantly shorter survival, at a median of 15 vs. 19 months (HR: 1.59, 95% CI: 1.07-2.37, p=0.023). However, for the subset of patients who underwent resection, survival was similar in the two groups (HR: 1.07, 95% CI: 0.66-1.73, p=0.773). A reduced time to surgery with avoidance of PBD offers survival benefit. This is only appreciated on ITT analysis, which includes patients who are initially considered candidates for surgery, but ultimately do not undergo surgery. Considering this 'hidden' cohort of patients is important when considering optimal pathways for the treatment of resectable pancreatic cancer.
Identifiants
pubmed: 33251128
doi: 10.3389/fonc.2020.526514
pmc: PMC7673268
doi:
Types de publication
Journal Article
Langues
eng
Pagination
526514Subventions
Organisme : Pancreatic Cancer UK
ID : CPA2015_05_BIRMINGHAM
Pays : United Kingdom
Informations de copyright
Copyright © 2020 Pande, Hodson, Marudanayagam, Chatzizacharias, Dasari, Muiesan, Sutcliffe, Mirza, Isaac and Roberts.
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