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Shahi N, Alaref A, Cerasuolo JO, Akhtar-Danesh N, Caswell JM, Serrano PE, Meyers BM, Savage DW, Nelli J, Patlas MN, Siltamaki D, Alabousi A, Siddiqui R, van der Pol CB. Impact of Wait Time From Preoperative CT to Pancreatectomy on Overall Survival for Patients With Pancreatic Carcinoma. Can Assoc Radiol J 2024:8465371241275150. [PMID: 39239946 DOI: 10.1177/08465371241275150] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 09/07/2024] Open
Affiliation(s)
| | - Amer Alaref
- NOSM University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre (TBRHSC), Thunder Bay, ON, Canada
| | - Joshua O Cerasuolo
- ICES North, Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Noori Akhtar-Danesh
- McMaster University, Hamilton, ON, Canada
- ICES McMaster, Faculty of Health Sciences, Hamilton, ON, Canada
| | - Joseph M Caswell
- ICES North, Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Pablo E Serrano
- McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | - Brandon M Meyers
- McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
- Escarpment Cancer Research Institute, Hamilton, ON, Canada
| | - David W Savage
- NOSM University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre (TBRHSC), Thunder Bay, ON, Canada
- ICES North, Health Sciences North Research Institute, Sudbury, ON, Canada
| | - Jennifer Nelli
- McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
| | | | - Dylan Siltamaki
- NOSM University, Thunder Bay, ON, Canada
- Thunder Bay Regional Health Sciences Centre (TBRHSC), Thunder Bay, ON, Canada
| | - Abdullah Alabousi
- McMaster University, Hamilton, ON, Canada
- St. Joseph's Healthcare Hamilton, Hamilton, ON, Canada
| | - Rabail Siddiqui
- Thunder Bay Regional Health Research Institute, Thunder Bay, ON, Canada
| | - Christian B van der Pol
- McMaster University, Hamilton, ON, Canada
- Juravinski Hospital and Cancer Centre, Hamilton Health Sciences, Hamilton, ON, Canada
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2
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Noda Y, Kobayashi K, Kawaguchi M, Ando T, Takai Y, Suto T, Iritani Y, Ishihara T, Fukada M, Murase K, Kawai N, Kaga T, Miyoshi T, Hyodo F, Kato H, Miyazaki T, Matsuhashi N, Yoshida K, Matsuo M. Assessment of Arterial Involvement in Pancreatic Cancer: Utility of Reconstructed CT Images Perpendicular to Artery. Cancers (Basel) 2024; 16:2271. [PMID: 38927975 PMCID: PMC11201929 DOI: 10.3390/cancers16122271] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 05/29/2024] [Revised: 06/11/2024] [Accepted: 06/13/2024] [Indexed: 06/28/2024] Open
Abstract
The purpose of this study was to investigate the utility of reconstructed CT images perpendicular to the artery for assessing arterial involvement from pancreatic cancer and compare the interobserver variability between it and the current diagnostic imaging method. This retrospective study included patients with pancreatic cancer in the pancreatic body or tail who underwent preoperative pancreatic protocol CT and distal pancreatectomy. Five radiologists used axial and coronal CT images (current method) and perpendicular reconstructed CT images (proposed method) to determine if the degree of solid soft-tissue contact with the splenic artery was ≤180° or >180°. The generalized estimating equations were used to compare the diagnostic performance of solid soft-tissue contact >180° between the current and proposed methods. Fleiss' ĸ statistics were used to assess interobserver variability. The sensitivity and negative predictive value for diagnosing solid soft-tissue contact >180° were higher (p < 0.001 for each) and the specificity (p = 0.003) and positive predictive value (p = 0.003) were lower in the proposed method than the current method. Interobserver variability was improved in the proposed method compared with the current method (ĸ = 0.87 vs. 0.67). Reconstructed CT images perpendicular to the artery showed higher sensitivity and negative predictive value for diagnosing solid soft-tissue contact >180° than the current method and demonstrated improved interobserver variability.
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Affiliation(s)
- Yoshifumi Noda
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
- Department of Frontier Science for Imaging, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Kazuhiro Kobayashi
- Department of Pathology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan; (K.K.); (T.M.)
| | - Masaya Kawaguchi
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Tomohiro Ando
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Yukiko Takai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Taketo Suto
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Yukako Iritani
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Takuma Ishihara
- Innovative and Clinical Research Promotion Center, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan;
| | - Masahiro Fukada
- Department of Gastroenterological Surgery and Pediatric Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.F.); (K.M.); (N.M.); (K.Y.)
| | - Katsutoshi Murase
- Department of Gastroenterological Surgery and Pediatric Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.F.); (K.M.); (N.M.); (K.Y.)
| | - Nobuyuki Kawai
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Tetsuro Kaga
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Toshiharu Miyoshi
- Department of Radiology Services, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan;
| | - Fuminori Hyodo
- Department of Pharmacology, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan;
- Center for One Medicine Innovative Translational Research (COMIT), Institute for Advanced Study, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan
| | - Hiroki Kato
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
| | - Tatsuhiko Miyazaki
- Department of Pathology, Gifu University Hospital, 1-1 Yanagido, Gifu 501-1194, Japan; (K.K.); (T.M.)
| | - Nobuhisa Matsuhashi
- Department of Gastroenterological Surgery and Pediatric Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.F.); (K.M.); (N.M.); (K.Y.)
| | - Kazuhiro Yoshida
- Department of Gastroenterological Surgery and Pediatric Surgery, Graduate School of Medicine, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.F.); (K.M.); (N.M.); (K.Y.)
| | - Masayuki Matsuo
- Department of Radiology, Gifu University, 1-1 Yanagido, Gifu 501-1194, Japan; (M.K.); (T.A.); (Y.T.); (T.S.); (Y.I.); (N.K.); (T.K.); (H.K.); (M.M.)
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de Jesus VHF, Riechelmann RP. Current Treatment of Potentially Resectable Pancreatic Ductal Adenocarcinoma: A Medical Oncologist's Perspective. Cancer Control 2023; 30:10732748231173212. [PMID: 37115533 PMCID: PMC10155028 DOI: 10.1177/10732748231173212] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Abstract] [Key Words] [MESH Headings] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 10/26/2022] [Revised: 03/01/2023] [Accepted: 04/06/2023] [Indexed: 04/29/2023] Open
Abstract
Pancreatic cancer has traditionally been associated with a dismal prognosis, even in early stages of the disease. In recent years, the introduction of newer generation chemotherapy regimens in the adjuvant setting has improved the survival of patients treated with upfront resection. However, there are multiple theoretical advantages to deliver early systemic therapy in patients with localized pancreatic cancer. So far, the evidence supports the use of neoadjuvant therapy for patients with borderline resectable pancreatic cancer. The benefit of this treatment sequence for patients with resectable disease remains elusive. In this review, we summarize the data on adjuvant therapy for pancreatic cancer and describe which evidence backs the use of neoadjuvant therapy. Additionally, we address important issues faced in clinical practice when treating patients with localized pancreatic cancer.
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Frountzas M, Liatsou E, Schizas D, Pergialiotis V, Vailas M, Kritikos N, Toutouzas KG. The impact of surgery delay on survival of resectable pancreatic cancer: A systematic review of observational studies. Surg Oncol 2022; 45:101855. [DOI: 10.1016/j.suronc.2022.101855] [Citation(s) in RCA: 0] [Impact Index Per Article: 0] [Reference Citation Analysis] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Received: 08/28/2022] [Revised: 09/12/2022] [Accepted: 09/26/2022] [Indexed: 12/05/2022]
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Mattevi C, Garnier J, Marchese U, Ewald J, Gilabert M, Poizat F, Piana G, Delpero JR, Turrini O. Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma? BMC Surg 2020; 20:176. [PMID: 32758203 PMCID: PMC7430808 DOI: 10.1186/s12893-020-00835-3] [Citation(s) in RCA: 2] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 06/05/2020] [Accepted: 07/27/2020] [Indexed: 12/19/2022] Open
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 (25% vs 24%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes 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 (7.9 mm vs 6.4 mm (P < .01), respectively) when the resection was not done. In multivariate analysis, CA 19–9 < 500 U/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.
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Affiliation(s)
- C Mattevi
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - J Garnier
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - U Marchese
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - J Ewald
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - M Gilabert
- Departement of Oncology, Institut Paoli-Calmettes, Marseille, France
| | - F Poizat
- Departement of Pathology, Institut Paoli-Calmettes, Marseille, France
| | - G Piana
- Departement of Radiology, Institut Paoli-Calmettes, Marseille, France
| | - J R Delpero
- Departement of Surgery, Institut Paoli-Calmettes, Marseille, France
| | - O Turrini
- Departement of Surgery, Aix-Marseille University, Institut Paoli-Calmettes, CRCM, 232 boulevard Sainte Marguerite, 13009, Marseille, France.
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Gastrointestinal Malignancies and the COVID-19 Pandemic: Evidence-Based Triage to Surgery. J Gastrointest Surg 2020; 24:2357-2373. [PMID: 32607860 PMCID: PMC7325836 DOI: 10.1007/s11605-020-04712-5] [Citation(s) in RCA: 38] [Impact Index Per Article: 9.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 04/27/2020] [Accepted: 06/22/2020] [Indexed: 02/08/2023]
Abstract
BACKGROUND The COVID-19 pandemic has led to widespread cancelation of electively scheduled surgeries, including for colorectal, pancreatic, and gastric cancer. The American College of Surgeons and the Society of Surgical Oncology have released guidelines for triage of these procedures. We seek to synthesize available evidence on delayed resection and oncologic outcomes, while also providing a critical assessment of the released guidelines. METHODS A systematic review was conducted to identify literature between 2005 and 2020 investigating the impact of time to surgery on oncologic outcomes in colorectal, pancreatic, and gastric cancer. RESULTS For colorectal cancer, 1066 abstracts were screened and 43 papers were included. In primarily resected colon cancer, delay over 30 to 40 days is associated with lower survival. In rectal cancer, time to surgery over 7 to 8 weeks following neoadjuvant therapy is associated with decreased survival. Three hundred ninety-four abstracts were screened for pancreatic cancer and nine studies were included. Two studies demonstrate increased unexpected progression with delayed surgery over 30 days. Out of 633 abstracts screened for gastric cancer, six studies were included. No identified study demonstrated worse survival with increased time to surgery. CONCLUSION Moderate evidence suggests that delayed resection of colorectal cancer worsens survival; the impact of time to surgery on gastric and pancreatic cancer outcomes is uncertain. Early resection of gastrointestinal malignancies provides the best chance for curative therapy. During the COVID-19 pandemic, prioritization of procedures should account for available evidence on time to surgery and oncologic outcomes.
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Lukács G, Kovács Á, Csanádi M, Moizs M, Repa I, Kaló Z, Vokó Z, Pitter JG. Benefits Of Timely Care In Pancreatic Cancer: A Systematic Review To Navigate Through The Contradictory Evidence. Cancer Manag Res 2019; 11:9849-9861. [PMID: 31819622 PMCID: PMC6875504 DOI: 10.2147/cmar.s221427] [Citation(s) in RCA: 19] [Impact Index Per Article: 3.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Subscribe] [Scholar Register] [Received: 07/01/2019] [Accepted: 10/15/2019] [Indexed: 11/23/2022] Open
Abstract
The evidence base of policies that improve the timeliness of cancer care is under ongoing debate. Pancreatic cancer is frequently diagnosed in a stage when curative therapy is not feasible; hence, it is an important target for timelier healthcare interventions. The objectives of our research were to identify all clinical studies on pancreatic cancer care delays via a systematic literature review, to assess the study methodologies for possible biases, to conclude on the available evidence, and to formulate research recommendations on evidence gaps. Nineteen studies were identified and eight reported multivariate analyses. Although many sources of bias shifted the results towards negative or paradoxical findings, a statistically significant association of shorter delays with better clinical outcomes was demonstrated in the majority of studies reporting multivariate analyses. Noninferiority analyses were not published. Further efforts to provide timely care for pancreatic cancer patients are encouraged, and studies on the associations of delay with patient experience and healthcare resource utilization are warranted.
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Affiliation(s)
- Gábor Lukács
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Árpád Kovács
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | | | | | - Imre Repa
- Móritz Kaposi General Hospital, Kaposvár, Hungary
- Doctoral School, Faculty of Health Sciences, University of Pécs, Pécs, Hungary
| | - Zoltán Kaló
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
| | - Zoltán Vokó
- Syreon Research Institute, Budapest, Hungary
- Department of Health Policy and Health Economics, Eötvös Loránd University, Budapest, Hungary
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Improving preoperative detection of synchronous liver metastases in pancreatic cancer with combined contrast-enhanced and diffusion-weighted MRI. Abdom Radiol (NY) 2019; 44:1756-1765. [PMID: 30659309 DOI: 10.1007/s00261-018-1867-7] [Citation(s) in RCA: 14] [Impact Index Per Article: 2.8] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Journal Information] [Subscribe] [Scholar Register] [Indexed: 12/26/2022]
Abstract
PURPOSE To explore the value of gadolinium-enhanced MRI combined with diffusion-weighted MRI (Gd-enhanced MRI with DWI) in addition to contrast-enhanced CT (CECT) for detection of synchronous liver metastases for potentially resectable pancreatic cancer. METHODS By means of a retrospective cohort study we included patients with potentially resectable pancreatic cancer on CECT, who underwent Gd-enhanced MRI with DWI between January 2012 and December 2016. A single observer evaluated MRI and CT and was blinded to imaging, pathology, and surgery reports. Liver lesions were scored in both modalities, using a 3-point scale: 1-benign, 2-indeterminate, 3- malignant (i.e., metastasis). The primary outcome parameters were the presence of liver metastases on Gd-enhanced MRI with DWI and the sensitivity of Gd-enhanced MRI with DWI for synchronous liver metastases. RESULTS We included 66 patients (42 men, 24 women; median age 65 years, range 36-82 years). In 19 patients, liver metastases were present, which were confirmed by histopathology (n = 12), 18FDG-PET (n = 6), or surgical inspection (n = 1). Gd-enhanced MRI with DWI showed metastases in 16/19 patients (24%), which resulted in a sensitivity of 84% (95% CI 60-97%). Contrast-enhanced MRI showed 156 and DWI 397 metastases (p = 0.051), and 339 were particularly small (< 5 mm). CONCLUSIONS In this study, Gd-enhanced MRI with DWI detected synchronous liver metastases in 24% of patients with potentially resectable pancreatic cancer on CECT with a sensitivity of 84%. Diffusion-weighted MRI showed a greater number of metastases than any other sequence, particularly small metastases (< 5 mm).
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Abstract
Pancreatic ductal adenocarcinoma (PDAC) remains a dismal prognosis and surgery is the only chance for cure. However, only few of the patients have localized tumor eligible for curative complete resection. Preoperative management and well-staging of the disease are the cornerstone for appropriate surgery and major issues to define the best therapeutic strategy. This review focuses on the surgical and optimal perioperative management of PDAC and summarizes updates data on the subject.
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Seo HK, Hwang DW, Park SY, Park Y, Lee SJ, Lee JH, Song KB, Lee YJ, Kim SC. The survival impact of surgical waiting time in patients with resectable pancreatic head cancer. Ann Hepatobiliary Pancreat Surg 2018; 22:405-411. [PMID: 30588533 PMCID: PMC6295371 DOI: 10.14701/ahbps.2018.22.4.405] [Citation(s) in RCA: 3] [Impact Index Per Article: 0.5] [Reference Citation Analysis] [Abstract] [Key Words] [Track Full Text] [Download PDF] [Figures] [Journal Information] [Submit a Manuscript] [Subscribe] [Scholar Register] [Received: 10/23/2018] [Revised: 10/25/2018] [Accepted: 10/26/2018] [Indexed: 12/26/2022] Open
Abstract
Backgrounds/Aims After centralization policy, clinical outcomes have been improved in patients underwent pancreaticoduodenectomy for pancreatic cancer. However, centralization could exacerbate the prolongation of surgical waiting time. This study aims to investigate whether the shorter waiting time correlates with the better survival and to identify the major confounders that influence the association between those. Methods In this retrospective cohort study, a total 554 patients with pathologically confirmed pancreatic ductal adenocarcinoma were assessed the eligibility from 2014 through 2015. Patients with neoadjuvant chemotherapy, body-tail resection, total pancreatectomy and combined adjacent organ resection were excluded. All patients were divided into two groups by median waiting time, 21 days, defined as the date difference between initial imaging diagnosis and operation. Results Median overall survival did not differ between long and short waiting group (30.4 vs 24.8 months, p=0.35; HR=0.84, 95% CI=0.58-1.21). The proportion of cancer stage shifting, the difference between clinical and pathologic staging, did not differ depending on waiting time group (p=0.811 and 0.255, each of reviewers). Short waiting time was highly correlated with high initial clinical stage (Spearman correlation coefficients -0.201 (p=0.006) and -0.100 (p=0.175), each of reviewers). Conclusions Initial clinical stage had confounding effect on the association between waiting time and overall survival. Therefore, in evaluating centralization policy at the national level, evidence for maximum acceptable waiting time should be investigated in the near future with considering that surgical waiting time could be affected by initial clinical stage.
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Affiliation(s)
- Hye Kyoung Seo
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Dae Wook Hwang
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seo Young Park
- Department of Clinical Epidemiology and Biostatistics, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Yejong Park
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Seung Jae Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Jae Hoon Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Ki Byung Song
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Young-Joo Lee
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
| | - Song Cheol Kim
- Division of Hepatobiliary and Pancreatic Surgery, Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, Seoul, Korea
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