Impact of social deprivation upon the preoperative pathway and early surgical outcomes after pancreatoduodenectomy for PDAC and non-PDAC periampullary cancer in England: the Surg-Panc-UK study

BACKGROUND: Socioeconomic deprivation is linked to poorer outcomes in many cancers, however the impact of social deprivation on survival in resectable pancreatic and other peri-ampullary cancers appears mixed. Moreover, no studies consider the impact of social deprivation on diagnostic pathway length.

METHODS: A retrospective observational cohort study of adults with suspected periampullary cancer undergoing pancreaticoduodenectomy in England. Following surgery, patients were stratified by cancer type (PDAC, duodenal cancer, cholangiocarcinoma and ampullary cancer) and the impact of social deprivation (IMD deprivation quintiles) upon short-term survival and diagnostic pathway length analysed.

RESULTS: 648 patients from England with social deprivation data were identified, including PDAC (n = 386) and non-PDAC periampullary malignancies (n = 262). For PDAC and non-PDAC patients, there was no association between resection rate and IMD quintile (p = 0.172 and p = 0.084). For PDAC patients, no difference in neoadjuvant chemotherapy rates (p = 0.462) or 1-year survival (p = 0.052) existed across IMD quintiles.

DISCUSSION: Across England socioeconomic deprivation does not appear to relate to survival outcomes after PD for periampullary cancer, regardless of histological subtype. This suggests that pancreatic resectional centres are managing health inequality well.