SP2.2 Time to Pancreaticoduodenectomy in a Regional Hepatobiliary Unit in the COVID recovery era

Aims

To assess factors influencing time from multidisciplinary (MDT) discussion to surgery for patients undergoing Whipple’s resection for malignant disease in a regional HPB unit.

Methods

Patients who underwent Whipple’s resection for cholangiocarcinoma, ampullary, duodenal and pancreatic ductal adenocarcinoma between 01/02/2021–29/11/2022 were identified from a prospectively maintained operative database. The NI Electronic Care Record was used to collect data.

Results

74 patients met the inclusion criteria. 83.8% (62/74) presented as an inpatient, compared to 74% in 2020. Patients presenting as an inpatient had a significantly shorter time to surgery than those presenting as outpatients (84.7vs152.8 days, p=0.03).

The average time from MDT to surgery without neoadjuvant therapy was 57 days. 20.3% (15/74) had neoadjuvant treatment with an average time to surgery of 248 days. This has increased since 2020 from 38 and 212 days respectively, however this was not statistically significant (p=0.051).

54.1% (40/74) had staging PET-CT compared to 26% of patients in 2020. Time to surgery with a PET-CT was not significantly different to those who had no PET-CT (107vs81.9 days, p=0.18).

13 patients (17.6%) had both ERCP and EUS. 52 patients (70.2%) had either EUS or ERCP. There is a significant difference in time to surgery for patients undergoing both EUS and ERCP compared to those undergoing one endoscopic procedure (224vs65.9 days, p=0.001).

Conclusions

Use of staging PET-CT and overall time to surgery has increased since 2020 however, this was not statistically significant. Presenting as an outpatient and undergoing both ERCP and EUS were two factors identified that lead to significant delays to surgery.