Time to Surgery: a Misguided Quality Metric in Early Stage Pancreatic Cancer

Katelin A. Mirkin, Christopher S. Hollenbeak, Joyce Wong

Research output: Contribution to journalArticle

3 Citations (Scopus)

Abstract

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.

Original languageEnglish (US)
Pages (from-to)1365-1375
Number of pages11
JournalJournal of Gastrointestinal Surgery
Volume22
Issue number8
DOIs
StatePublished - Aug 1 2018

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Pancreatic Neoplasms
Survival
Adenocarcinoma
Neoadjuvant Therapy
Kaplan-Meier Estimate
Medicare
Comorbidity
Linear Models
Neoplasms
Databases
Therapeutics

All Science Journal Classification (ASJC) codes

  • Surgery
  • Gastroenterology

Cite this

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title = "Time to Surgery: a Misguided Quality Metric in Early Stage Pancreatic Cancer",
abstract = "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.",
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Time to Surgery : a Misguided Quality Metric in Early Stage Pancreatic Cancer. / Mirkin, Katelin A.; Hollenbeak, Christopher S.; Wong, Joyce.

In: Journal of Gastrointestinal Surgery, Vol. 22, No. 8, 01.08.2018, p. 1365-1375.

Research output: Contribution to journalArticle

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