A Delay to Pancreatic Resections. A Retrospective Cohort Study on the Impact of SARS-CoV-2 on the Operative Treatment Pathway for Pancreatic Malignancy at a UK HPB Unit

Purpose: Disruption to NHS services due to the Covid pandemic has had detrimental impacts on patients with suspected pancreatic malignancy. A delay to surgical resection with a curative intent can lead to an increase in abandoned procedures due to disease progression. The aim of this study was to help identify the potential delays in patients undergoing pancreatic resections at a UK Hepatobiliary Centre. Method: A prospectively maintained database of 176 pancreatic resections undertaken between 01/01/19 and 31/12/20 at The University of Manchester NHS Foundation Trust were included. The dates off first diagnostic imaging; first MDT; decision to resect MDT and last cross-sectional imaging prior to surgery were retrospectively collected using the trusts Electronic Patient Records and the Somerset Cancer Registry. Pancreatic resections undertaken for suspected or histologically proven benign conditions were excluded. 88 resections were performed in both 2019 and 2020. The time in days between these critical dates were compared. Results: Time taken from first diagnostic imaging to date of operation was significantly longer in 2020 when compared to 2019 (median time 71.5 vs 58.5 p = 0.035). Significant delays were also seen between last imaging and date of operation (median time 28.5 vs 15.0 p = 0.001) and between decision to resect MDT and date of operation (median time 35.0 vs 27.0 p = 0.011). Conclusion: This study has shown the significant impact SARS-CoV-2 has had on the delay to treatment for patients undergoing pancreatic resection for histologically proven malignant lesions. These delays have been witnessed across all vital steps in the patient pathway. The impact of such delays can lead to the possible diagnosis of unresectable disease at the time of surgery leading to a rise in abandoned procedures for pancreatic resection. The associated psychological and physical morbiditiy to the patient is unimaginable and certainly preventable with focus on streamlining services to prevent such delays. This is an unprecedented situation, however recognising there is a delay will allow service providers to adapt and modify the patient pathway to reduce the overall impact of SARS-COV-2.