SRS309 - Implementation and evaluation of a two-week fast-track whipple pathway with integrated PET imaging for pancreatic cancer patients

Pancreatic cancer has a 5-year survival rate of less than 10%. Approximately 15% of patients present with resectable disease at diagnosis. The narrow window of opportunity for curative intervention makes time a critical factor in pancreatic cancer management. This prospective cohort study assesses the impact of London’s first fast-track Whipple’s pathway since its introduction in September 2023. We evaluate its effectiveness in expediting surgical management for patients with suspected pancreatic cancer, with a target of achieving surgery within 15 days of referral for 90% of eligible patients. Forty-three patients were enrolled in the pathway, with a median age of 66 and an equal sex distribution. The median pre-operative bilirubin level was 189. The median interval from referral to FDG-PET was 7 days, and from referral to surgery was 12 days, a significant reduction compared to the traditional pathway. Thirty-eight patients (88.3%) successfully underwent pancreatic resection (28 standard Whipple’s procedures, 6 Whipple’s with portal vein resection, 3 total pancreatectomies, and 1 extrahepatic bile duct resection). Histopathological analysis revealed that 79% of cases were adenocarcinoma, 12% cholangiocarcinoma, and 7.6% comprised benign lesions, GIST, and metastatic lobular carcinoma. Clinical outcomes have been favourable, with 44% of patients achieving R0 resection and 15.7% presenting with N2 stage disease. Thirty-five patients (81%) experienced a good recovery at 30 days post-surgery. These results align with international literature on expedited pathways, reducing the need for preoperative biliary stenting and the inflammatory complications seen in the 60-day traditional pathway; this represents a cost-effective advantage warranting further comparative evaluation.