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Langenbeck's Archives of Surgery

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01-05-2020 | Computed Tomography | Systematic Reviews and Meta-analyses

Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis

Authors: Philip C. Müller, James Hodson, Christoph Kuemmerli, Marit Kalisvaart, Rupaly Pande, Keith J. Roberts

Published in: Langenbeck's Archives of Surgery | Issue 3/2020

Abstract

Purpose

Achieving surgical resection is essential if patients with pancreatic ductal adenocarcinoma (PDAC) have a chance for cure. The objective of this study was to evaluate the effect of time to surgery on resection rates in patients with resectable PDAC.

Methods

A systematic literature search was performed to identify studies reporting times to surgery and resection rates. Meta-regression models were then produced to assess the relationship between time to surgery and resection rates, using both intra- and inter-study comparisons.

Results

A total of 21 studies were included, comprising n = 2171 patients, with a pooled resection rate of 76%. Intra-study meta-analysis of the five studies that reported comparisons between patients with vs. without preoperative biliary drainage (PBD) or with long vs. short delays to surgery found earlier surgery to be associated with a significantly higher rate of resection (pooled odds ratio 1.93, 95% CI: 1.25–2.97, P = 0.003). Inter-study meta-regression across all studies found a tendency for resection rates to decline with increasing time from CT or ERCP to surgery (gradient − 0.13 log-odds per week, 95% CI − 0.28, 0.03, P = 0.100), although this did not reach statistical significance, in part due to considerable heterogeneity between studies.

Conclusion

Pathways to reduce the time to surgery, primarily by avoiding PBD, demonstrate significantly greater resection rates. Early surgery, including avoidance of PBD, not only provides patients with the benefit of avoiding harm associated with PBD but also with a greater chance of undergoing resection.

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Title: Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis
Authors: Philip C. Müller
James Hodson
Christoph Kuemmerli
Marit Kalisvaart
Rupaly Pande
Keith J. Roberts
Publication date: 01-05-2020
Publisher: Springer Berlin Heidelberg
Keywords: Computed Tomography
Computed Tomography
Pancreatic Cancer
Pancreatic Cancer
Published in: Langenbeck's Archives of Surgery / Issue 3/2020
Print ISSN: 1435-2443
Electronic ISSN: 1435-2451
DOI: https://doi.org/10.1007/s00423-020-01893-0

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Springer Medicine

Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis

Abstract

Purpose

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Purpose

Methods

Results

Conclusion

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