Progression of resectable pancreatic ductal adenocarcinoma during surgical delay and effects on survival - A propensity score matched study.

Background: Surgery is the only curative treatment for pancreatic cancer, but less than 25 % of the patients present with a resectable tumor at the time of diagnosis. The aim of this study is to evaluate progression during surgical treatment delay and examine any associations between surgical treatment delay and survival.

Methods: This is a retrospective, single center propensity score matched study including treatment naïve patients with pancreatic adenocarcinoma between 2018 and 2022. Outcomes included disease progression during surgical treatment delay in patients where follow-up imaging was performed as well as overall and recurrence-free survival for the entire cohort.

Results: The study cohort consisted of 290 patients of whom 129 (44.5 %) underwent follow-up imaging. Radiological progression to unresectable disease during surgical delay was seen in 14 cases (10.9 %), with another 17 cases (13.2 %) deemed unresectable during intended resection. Tumor size progression was observed in 29 patients (22.5 %) with an average tumor growth rate of 7.4 mm (95%CI 5.8-8.9, p < 0.001). Median time to surgery was 37 days with no observed associations between treatment delay and overall survival (HR = 1.02, 95%CI 0.76-1.38, p = 0.996), or the risk of recurrence (HR = 1.06, 95%CI 0.77-1.48, p = 0.709).

Conclusion: Progression in tumor size does not seem to affect survival in our study population. In general, surgical treatment delay in up-front resectable patients does not seem to be associated with survival or the risk of recurrence, but the optimal and maximal time to surgery as well as the optimal timing of the follow-up scanning remain unclear.