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

  • Systematic Reviews and Meta-analyses
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

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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Abbreviations

CT:

Computed tomography

CE:

Contrast-enhanced

ERCP:

Endoscopic retrograde cholangio-pancreatography

PDAC:

Pancreatic ductal adenocarcinoma

PBD:

Preoperative biliary drainage

NHS:

National health service

RCTs:

Randomized controlled trials

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Funding

The study was funded by institutional means.

Author information

Authors and Affiliations

  1. Department of Surgery, University Hospital Zurich, Zurich, Switzerland

    Philip C. Müller, Christoph Kuemmerli & Marit Kalisvaart

  2. Institute of Translational Medicine, University Hospitals Birmingham, Birmingham, B15 2TH, UK

    James Hodson

  3. Department of Hepatobiliary Pancreatic Surgery, University Hospital Birmingham, Rm 41e 3rd Floor Nuffield House, Queen Elizabeth Hospital, Mindelsohn Way, Edgbaston, Birmingham, B15 2TH, UK

    Marit Kalisvaart, Rupaly Pande & Keith J. Roberts

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  1. Philip C. Müller
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  5. Rupaly Pande
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  6. Keith J. Roberts
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Contributions

PCM: study design, literature search, data extraction, writing the manuscript; JH: study design, statistical analysis, writing the manuscript; CK: literature search, data extraction, critical revision of the manuscript; MK, RP: literature search, interpretation of data, critical revision of the manuscript; KJR: study design, interpretation of data, writing the manuscript.

Corresponding author

Correspondence to Keith J. Roberts.

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The authors declare that they have no conflict of interest.

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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki declaration and its later amendments or comparable ethical standards.

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Not applicable due to the nature of the study design.

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Müller, P.C., Hodson, J., Kuemmerli, C. et al. Effect of time to surgery in resectable pancreatic cancer: a systematic review and meta-analysis. Langenbecks Arch Surg 405, 293–302 (2020). https://doi.org/10.1007/s00423-020-01893-0

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  • DOI: https://doi.org/10.1007/s00423-020-01893-0

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