Aiming for high quality of care for completed resections and improved margin status in pancreatic cancer surgery

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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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