Time to Surgery: a Misguided Quality Metric in Early Stage Pancreatic Cancer.
J Gastrointest Surg. 2018 Aug;22(8):1365-1375. doi: 10.1007/s11605-018-3730-0. Epub 2018 Mar 8. Mirkin KA1, Hollenbeak CS1,2, Wong J3.
BACKGROUND: Longer time to surgery is associated with worse outcomes in several cancers. We sought to identify disparities in time from diagnosis to surgery in pancreatic cancer and whether delays to surgery correlated with worse survival.
METHODS: The US National Cancer Database (2003-2011) was reviewed for patients with clinical stages I-II pancreatic adenocarcinoma who underwent surgical resection. Patients who received neoadjuvant therapy were excluded. Linear regression, Kaplan-Meier analyses, and Cox regression were performed as 3-month landmark analyses.
RESULTS: Of the 14,807 patients included, 37.8% underwent resection ≤ 1 week, 13.7% 1-2 weeks, 25.4% 2-4 weeks, 19.5% 4-8 weeks, and 3.7% 8-12 weeks. Older age, Medicare coverage, greater distance from hospital, treatment at an academic center, and greater comorbidities were associated with increased time. After excluding patients treated within 1 week of diagnosis and controlling for patient, disease, and treatment characteristics, greater time was not associated with worse survival (2-4, HR 1.03, P = 0.399; 4-8, HR 0.98, P = 0.529; 8-12, P = 0.123).
CONCLUSIONS: For patients with stages I-II pancreatic adenocarcinoma, there are disparities in surgical wait times. However, earlier initiation of surgical resection within 12 weeks of diagnosis is not associated with a survival benefit. This suggests that allowing time for confirmatory testing and optimization in preparation for surgery may not negatively impact survival.