Aiming for high quality of care for completed resections and improved margin status in pancreatic cancer surgery
Ashika D. Maharaj (Monash University, TU Delft - Policy Analysis)
Bronwyn Brown (Monash University)
Hamish Evans (Monash University)
Sue M. Evans (Monash University, Cancer Council Victoria)
Liane J. Ioannou (Monash University)
Arul Earnest (Monash University)
Daniel Croagh (Monash Health)
Charles H.C. Pilgrim (Alfred Health)
Elysia Greenhill (Monash University)
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Abstract
Purpose
To assess associations between six diagnostic, staging, and coordination of care indicators in pancreatic cancer, and: (1) surgery being abandoned intraoperatively; or (2) a positive macroscopic margin (R2 resection) or a positive microscopic pathological margin (R1 resection).
Methods
Data was provided by the Upper Gastrointestinal Cancer Registry operating across two Australian states. Associations were tested using multivariable logistic regression.
Results
704 patients underwent an attempted surgical resection (54 % male; median age 69 years). Of the completed resections (n = 585) with a known margin status (n = 513), 54 % (n = 278) were reported as having a negative pathological (R0) margin, 41 % (n = 211) had an R1 margin, and 5 % (n = 24) had an R2 margin. Patients who underwent surgery or neoadjuvant therapy within 60 days from referral had double the odds of a complete resection (OR=2.12, 95 % CI, 1.19 – 3.76). Imaging undertaken beyond 30 days prior to surgery had a 40 % reduction in the odds of a completed resection (OR=0.58, 95 % CI, 0.37 – 0.92). Patients with their ECOG and/or ASA documented at presentation had 90 % increased odds of a R0 margin resection (OR=1.90, 95 % CI, 1.32 – 2.73).
Conclusions
Timely progression to primary treatment had the most significant association with achieving complete resection status.
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