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Published on: May 24, 2024
Increasing time delay from presentation until surgical referral for hepatobiliary malignancies
Kristopher P Croome1, Robyn Chudzinski, Douglas W Hanto
1Center for Transplant Outcomes and Quality Improvement, The Transplant Institute at Beth Israel Deaconess Medical Center and Harvard Medical School, Boston, MA 02215, USA. krisbelize@hotmail.com
Summary
Delayed diagnosis and treatment of hepatobiliary (HB) malignancies increase imaging studies and adversely affect survival in resected patients. Early referral to an HB surgeon is crucial for timely evaluation and treatment.
Area of Science:
- Hepatobiliary Surgery
- Surgical Oncology
- Medical Diagnostics
Background:
- Delayed treatment of non-hepatobiliary (HB) malignancies is linked to adverse outcomes.
- The impact of delayed treatment on HB malignancies remains under-investigated.
Purpose of the Study:
- To investigate time delays (TD) in patient workup for HB malignancies.
- To identify reasons for delays and demographic disparities in TD.
- To assess the impact of TD on survival in resectable HB patients.
Main Methods:
- Retrospective review of patients referred to the Hepatobiliary Surgery Service (2002-2008).
- Analysis of primary outcomes: time delays (TD) in patient workup.
- Secondary outcomes: reasons for delay, demographic disparities, and survival impact.
Main Results:
- A significant trend of increasing time from presentation to HB surgeon referral was observed (P=0.001).
- No demographic differences (gender, age, education) in TD were found.
- A significant increase in imaging studies (CT, MRI, PET, US/EUS) prior to referral was noted (P < 0.001).
- Patients with TD1 > 30 days had significantly reduced survival compared to those with TD1 < 30 days (P = 0.042).
Conclusions:
- Delays in HB malignancy care are associated with increased imaging utilization.
- Delayed treatment adversely affects survival in resectable HB patients.
- Expedited evaluation and early referral to HB surgeons are recommended.
