Association between waiting time and survival in patients undergoing local treatment for biliary tract cancer: a nationwide study

Purpose Biliary tract cancers are aggressive malignancies with low survival rates. Therefore, the delays in receiving treatment could represent a challenge to successful outcomes. However, recent evidence suggests that extended waiting times for surgery in digestive cancers do not affect survival. This study investigated the association between the interval from multidisciplinary team (MDT)-based suspected diagnosis to initiation of local treatment and survival among patients with biliary tract cancer. Methods This was a nationwide, multicenter, cohort study based on data from patients locally treated for intrahepatic cholangiocarcinoma, perihilar cholangiocarcinoma, and gallbladder cancer from 2013 to 2023. Results Registry data from 303 patients were analyzed. The median waiting time from diagnosis to treatment for the entire cohort was 28.0 days, with an interquartile range of 21.0–41.0 days. Multivariable restricted cubic spline analysis suggested a statistically significant and a borderline non-linear, association between waiting time to treatment and overall survival (overall Wald χ2 = 67.5, p = < 0.0001; non-linear Wald χ2 = 5.8, p = 0.053; C-index = 0.33). Doubtful operability and resection of extrahepatic bile ducts were associated with long waits in intrahepatic cholangiocarcinoma (p = < 0.001 and p = 0.003, respectively). Futile laparotomy was associated with short waiting times in gallbladder cancer ( p = 0.027). Conclusion We observed a potential U-shaped, non-linear relationship between waiting time and survival. Kaplan-Meier analyses did not identify statistically significant differences according to the median waiting time. Doubtful operability, resection of extrahepatic bile ducts, and futile laparotomy were associated with waiting time to local treatment.