Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study.
Cancer
Pancreas
Pancreatic neoplasms
Review
Surgery
Survey
Journal
Updates in surgery
ISSN: 2038-3312
Titre abrégé: Updates Surg
Pays: Italy
ID NLM: 101539818
Informations de publication
Date de publication:
Jan 2023
Jan 2023
Historique:
received:
16
04
2022
accepted:
31
10
2022
pubmed:
15
11
2022
medline:
14
1
2023
entrez:
14
11
2022
Statut:
ppublish
Résumé
Very few surveys have been carried out of oncosurgical decisions made in patients with pancreatic cancer (PC), or of the possible differences in therapeutic approaches between low/medium and high-volume centers. A survey was sent out to centers affiliated to the Spanish Group of Pancreatic Surgery (GECP) asking about their usual pre-, intra- and post-operative management of PC patients and describing five imaginary cases of PC corresponding to common scenarios that surgeons regularly assess in oncosurgical meetings. A consensus was considered to have been reached when 80% of the answers coincided. We received 69 responses from the 72 GECP centers (response rate 96%). Pre-operative management: consensus was obtained on 7/16 questions (43.75%) with no significant differences between low- vs high-volume centers. Intra-operative: consensus was obtained on 11/28 questions (39.3%). D2 lymphadenectomy, biliary culture, intra-operative biliary margin study, pancreatojejunostomy, and two loops were significantly more frequent in high-volume hospitals (p < 0.05). Post-operative: consensus was obtained on 2/8 questions (25%). No significant differences were found between low-/medium- vs high-volume hospitals. Of the 41 questions asked regarding the cases, consensus was reached on 22 (53.7%). No differences in the responses were found according to the type of hospital. Management and cases: consensus was reached in 42/93 questions (45.2%). At GECP centers, consensus was obtained on 45% of the questions. Only 5% of the answers differed between low/medium and high-volume centers (all intra-operative). A more specific assessment of why high-volume centers obtain the best results would require the design of complex prospective studies able to measure the therapeutic decisions made and the effectiveness of their execution. Clinicaltrials.gov identifier: NCT04755036.
Identifiants
pubmed: 36376560
doi: 10.1007/s13304-022-01415-1
pii: 10.1007/s13304-022-01415-1
doi:
Banques de données
ClinicalTrials.gov
['NCT04755036']
Types de publication
Journal Article
Langues
eng
Sous-ensembles de citation
IM
Pagination
115-131Informations de copyright
© 2022. Italian Society of Surgery (SIC).
Références
Hidalgo M, Álvarez R, Gallego J, Guillén-Ponce C, Laquente B, Macarulla T, Muñoz A, Salgado M, Vera R, Adeva J, Alés I, Arévalo S, Blázquez J, Calsina A, Carmona A, de Madaria E, Díaz R, Díez L, Fernández T, de Paredes BG, Gallardo ME, González I, Hernando O, Jiménez P, López A, López C, López-Ríos F, Martín E, Martínez J, Martínez A, Montans J, Pazo R, Plaza JC, Peiró I, Reina JJ, Sanjuanbenito A, Yaya R, Carrato A (2017) Consensus guidelines for diagnosis, treatment and follow-up of patients with pancreatic cancer in Spain. Clin Transl Oncol 19(6):667–681. https://doi.org/10.1007/s12094-016-1594-x
doi: 10.1007/s12094-016-1594-x
Sabater L, Muñoz E, Roselló S, Dorcaratto D, Garcés-Albir M, Huerta M, Roda D, Gómez-Mateo MC, Ferrández-Izquierdo A, Darder A, Cervantes A (2018) Borderline resectable pancreatic cancer. Challenges and controversies. Cancer Treat Rev 68:124–135. https://doi.org/10.1016/j.ctrv.2018.06.006
doi: 10.1016/j.ctrv.2018.06.006
Huang L, Jansen L, Balavarca Y, Molina-Montes E, Babaei M, van der Geest L, Lemmens V, Van Eycken L, De Schutter H, Johannesen TB, Fristrup CW, Mortensen MB, Primic-Žakelj M, Zadnik V, Becker N, Hackert T, Mägi M, Cassetti T, Sassatelli R, Grützmann R, Merkel S, Gonçalves AF, Bento MJ, Hegyi P, Lakatos G, Szentesi A, Moreau M, van de Velde T, Broeks A, Sant M, Minicozzi P, Mazzaferro V, Real FX, Carrato A, Molero X, Besselink MG, Malats N, Büchler MW, Schrotz-King P, Brenner H (2019) Resection of pancreatic cancer in Europe and USA: an international large-scale study highlighting large variations. Gut 68(1):130–139. https://doi.org/10.1136/gutjnl-2017-314828
doi: 10.1136/gutjnl-2017-314828
Chen X, Yi B, Liu Z, Zou H, Zhou J, Zhang Z, Xiong L, Wen Y (2020) Global, regional and national burden of pancreatic cancer, 1990 to 2017: Results from the Global Burden of Disease Study 2017. Pancreatology 20(3):462–469. https://doi.org/10.1016/j.pan.2020.02.01
doi: 10.1016/j.pan.2020.02.01
Kasumova GG, Eskander MF, de Geus SWL, Neto MM, Tabatabaie O, Ng SC, Miksad RA, Mahadevan A, Rodrigue JR, Tseng JF (2017) Regional variation in the treatment of pancreatic adenocarcinoma: Decreasing disparities with multimodality therapy. Surgery 162(2):275–284. https://doi.org/10.1016/j.surg.2017.03.009
doi: 10.1016/j.surg.2017.03.009
Vera R, Dotor E, Feliu J, González E, Laquente B, Macarulla T, Martínez E, Maurel J, Salgado M, Manzano JL (2016) SEOM Clinical Guideline for the treatment of pancreatic cancer (2016). Clin Transl Oncol 18(12):1172–1178. https://doi.org/10.1007/s12094-016-1586-x
doi: 10.1007/s12094-016-1586-x
Groen JV, Sibinga Mulder BG, van Eycken E, Valerianova Z, Borras JM, van der Geest LGM, Capretti G, Schlesinger-Raab A, Primic-Zakelj M, Ryzhov A, van de Velde CJH, Bonsing BA, Bastiaannet E, Mieog JSD (2018) Differences in treatment and outcome of pancreatic adenocarcinoma stage I and II in the EURECCA pancreas consortium. Ann Surg Oncol 25(12):3492–3501. https://doi.org/10.1245/s10434-018-6705-1
doi: 10.1245/s10434-018-6705-1
Cyr DP, Truong JL, Lam-McCulloch J, Cleary SP, Karanicolas PJ (2015) Canadian practice patterns for pancreaticoduodenectomy. Can J Surg 58(2):121–127. https://doi.org/10.1503/cjs.011714
doi: 10.1503/cjs.011714
Versteijne E, Vogel JA, Besselink MG, Busch ORC, Wilmink JW, Daams JG, van Eijck CHJ, Groot Koerkamp B, Rasch CRN, van Tienhoven G, Dutch Pancreatic Cancer Group (2018) Meta-analysis comparing upfront surgery with neoadjuvant treatment in patients with resectable or borderline resectable pancreatic cancer. Br J Surg 105(8):946–958. https://doi.org/10.1002/bjs.10870
doi: 10.1002/bjs.10870
Mamidanna R, Ni Z, Anderson O, Spiegelhalter SD, Bottle A, Aylin P, Faiz O, Hanna GB (2016) Surgeon volume and cancer esophagectomy, gastrectomy, and pancreatectomy: a population-based study in England. Ann Surg 263(4):727–732. https://doi.org/10.1097/SLA.0000000000001490
doi: 10.1097/SLA.0000000000001490
Nimptsch U, Krautz C, Weber GF, Mansky T, Grützmann R (2016) Nationwide In-hospital mortality following pancreatic surgery in germany is higher than anticipated. Ann Surg 264(6):1082–1090. https://doi.org/10.1097/SLA.0000000000001693
doi: 10.1097/SLA.0000000000001693
McMillan MT, Malleo G, Bassi C, Sprys MH, Vollmer CM Jr (2015) Defining the practice of pancreatoduodenectomy around the world. HPB (Oxford) 17:1145–1154. https://doi.org/10.1111/hpb.12475
doi: 10.1111/hpb.12475
Abbott DE, Martin G, Kooby DA, Merchant NB, Squires MH, Maithel SK, Weber SM, Winslow ER, Cho CS, Bentrem DJ, Kim HJ, Scoggins CR, Martin RC, Parikh AA, Hawkins WG, Ahmad SA (2016) Perception is reality: quality metrics in pancreas surgery—a Central Pancreas Consortium (CPC) analysis of 1399 patients. HPB (Oxford) 18(5):462–469. https://doi.org/10.1016/j.hpb.2015.11.006
doi: 10.1016/j.hpb.2015.11.006
Visser BC, Ma Y, Zak Y, Poultsides GA, Norton JA, Rhoads KF (2012) Failure to comply with NCCN guidelines for the management of pancreatic cancer compromises outcomes. HPB (Oxford) 14:539–547. https://doi.org/10.1111/j.1477-2574.2012.00496.x
doi: 10.1111/j.1477-2574.2012.00496.x
NCCN Pancreatic Adenocarcinoma Guidelines Version 1.2022. https://www.nccn.org/professionals/physician_gls/pdf/pancreatic.pdf . Accessed 15 Mar 2022
Sánchez-Velázquez P, Muller X, Malleo G, Park JS, Hwang HK, Napoli N, Javed AA, Inoue Y, Beghdadi N, Kalisvaart M, Vigia E, Walsh CD, Lovasik B, Busquets J, Scandavini C, Robin F, Yoshitomi H, Mackay TM, Busch OR, Hartog H, Heinrich S, Gleisner A, Perinel J, Passeri M, Lluis N, Raptis DA, Tschuor C, Oberkofler CE, DeOliveira ML, Petrowsky H, Martinie J, Asbun H, Adham M, Schulick R, Lang H, Koerkamp BG, Besselink MG, Han HS, Miyazaki M, Ferrone CR, Fernández-Del Castillo C, Lillemoe KD, Sulpice L, Boudjema K, Del Chiaro M, Fabregat J, Kooby DA, Allen P, Lavu H, Yeo CJ, Barroso E, Roberts K, Muiesan P, Sauvanet A, Saiura A, Wolfgang CL, Cameron JL, Boggi U, Yoon DS, Bassi C, Puhan MA, Clavien PA (2019) Benchmarks in pancreatic surgery: a novel tool for unbiased outcome comparisons. Ann Surg 270(2):211–218. https://doi.org/10.1097/SLA.0000000000003223
doi: 10.1097/SLA.0000000000003223
Bockhorn M, Uzunoglu FG, Adham M, Imrie C, Milicevic M, Sandberg AA, Asbun HJ, Bassi C, Büchler M, Charnley RM, Conlon K, Cruz LF, Dervenis C, Fingerhutt A, Friess H, Gouma DJ, Hartwig W, Lillemoe KD, Montorsi M, Neoptolemos JP, Shrikhande SV, Takaori K, Traverso W, Vashist YK, Vollmer C, Yeo CJ, Izbicki JR, International Study Group of Pancreatic Surgery (2014) Borderline resectable pancreatic cancer: a consensus statement by the International Study Group of Pancreatic Surgery (ISGPS). Surgery 155(6):977–988. https://doi.org/10.1016/j.surg.2014.02.001
doi: 10.1016/j.surg.2014.02.001
Scholten L, van Huijgevoort NCM, Bruno MJ, Fernandez-Del Castillo C, Satoi S, Sauvanet A, Wolfgang C, Fockens P, Chari ST, Del Chiaro M, van Hooft JE, Besselink MG, European Study Group on Cystic Tumours of the Pancreas and the International Association of Pancreatology (2018) Surgical management of intraductal papillary mucinous neoplasm with main duct involvement: an international expert survey and case-vignette study. Surgery 16:S0039-6060(18)30082–5. https://doi.org/10.1016/j.surg.2018.01.025
doi: 10.1016/j.surg.2018.01.025
Müssle B, Distler M, Wolk S, Shrikhande SV, Aust DE, Arlt A, Weitz J, Hackert T, Welsch T (2017) Management of patients with pancreatic cystic lesions: A case-based survey. Pancreatology 17(3):431–437. https://doi.org/10.1016/j.pan.2017.04.004
doi: 10.1016/j.pan.2017.04.004
Melloul E, Lassen K, Roulin D, Grass F, Perinel J, Adham M, Wellge EB, Kunzler F, Besselink MG, Asbun H, Scott MJ, Dejong CHC, Vrochides D, Aloia T, Izbicki JR, Demartines N (2020) Guidelines for perioperative care for pancreatoduodenectomy: enhanced recovery after surgery (ERAS) recommendations 2019. World J Surg 44(7):2056–2084. https://doi.org/10.1007/s00268-020-05462-w
doi: 10.1007/s00268-020-05462-w
Tol JA, Gouma DJ, Bassi C, Dervenis C, Montorsi M, Adham M, Andrén-Sandberg A, Asbun HJ, Bockhorn M, Büchler MW, Conlon KC, Fernández-Cruz L, Fingerhut A, Friess H, Hartwig W, Izbicki JR, Lillemoe KD, Milicevic MN, Neoptolemos JP, Shrikhande SV, Vollmer CM, Yeo CJ, Charnley RM, International Study Group on Pancreatic Surgery (2014) Definition of a standard lymphadenectomy in surgery for pancreatic ductal adenocarcinoma: a consensus statement by the International Study Group on Pancreatic Surgery (ISGPS). Surgery 156(3):591–600. https://doi.org/10.1016/j.surg.2014.06.016
doi: 10.1016/j.surg.2014.06.016
Sabater L, García-Granero A, Escrig-Sos J, Gómez-Mateo MC, Sastre J, Ferrández A, Ortega J (2014) Outcome quality standards in pancreatic oncologic surgery. Ann Surg Oncol 21:1138–1146. https://doi.org/10.1245/s10434-013-3451-2
doi: 10.1245/s10434-013-3451-2
Ratnayake CB, Wells CI, Kamarajah SK, Loveday B, Sen G, French JJ, White S, Pandanaboyana S (2020) Critical appraisal of the techniques of pancreatic anastomosis following pancreaticoduodenectomy: a network meta-analysis. Int J Surg 73:72–77. https://doi.org/10.1016/j.ijsu.2019.12.003
doi: 10.1016/j.ijsu.2019.12.003
Brauer DG, Strand MS, Sanford DE, Kushnir VM, Lim KH, Mullady DK, Tan BR Jr, Wang-Gillam A, Morton AE, Ruzinova MB, Parikh PJ, Narra VR, Fowler KJ, Doyle MB, Chapman WC, Strasberg SS, Hawkins WG, Fields RC (2017) Utility of a multidisciplinary tumor board in the management of pancreatic and upper gastrointestinal diseases: an observational study. HPB (Oxford) 19(2):133–139. https://doi.org/10.1016/j.hpb.2016.11.002
doi: 10.1016/j.hpb.2016.11.002
Ahola R, Siiki A, Vasama K, Vornanen M, Sand J, Laukkarinen J (2017) Effect of centralization on long-term survival after resection of pancreatic ductal adenocarcinoma. Br J Surg 104:1532–1538. https://doi.org/10.1177/1457496919900411
doi: 10.1177/1457496919900411
Polonski A, Izbicki JR, Uzunoglu FG (2019) Centralization of pancreatic surgery in Europe. J Gastrointest Surg 23:2081–2092. https://doi.org/10.1007/s11605-019-04215-y
doi: 10.1007/s11605-019-04215-y
Stella M, Bissolati M, Gentile D, Arriciati A (2017) Impact of surgical experience on management and outcome of pancreatic surgery performed in high- and low-volume centers. Updates Surg 69:351–358. https://doi.org/10.1007/s13304-017-0422-3
doi: 10.1007/s13304-017-0422-3
Okusaka T, Nakamura M, Yoshida M, Kitano M, Uesaka K, Ito Y, Furuse J, Hanada K, Okazaki K, Committee for Revision of Clinical Guidelines for Pancreatic Cancer of the Japan Pancreas Society (2020) Clinical practice guidelines for pancreatic cancer 2019 from the Japan Pancreas Society: A Synopsis. Pancreas 49(3):326–335. https://doi.org/10.1097/MPA.0000000000001513
doi: 10.1097/MPA.0000000000001513
Partelli S, Mazza M, Andreasi V, Muffatti F, Crippa S, Tamburrino D, Falconi M (2019) Management of small asymptomatic nonfunctioning pancreatic neuroendocrine tumors: Limitations to apply guidelines into real life. Surgery 166:157–163. https://doi.org/10.1016/j.surg.2019.04.003
doi: 10.1016/j.surg.2019.04.003
Versteijne E, Suker M, Groothuis K, Akkermans-Vogelaar JM, Besselink MG, Bonsing BA, Buijsen J, Busch OR, Creemers GM, van Dam RM, Eskens FALM, Festen S, de Groot JWB, Groot Koerkamp B, de Hingh IH, Homs MYV, van Hooft JE, Kerver ED, Luelmo SAC, Neelis KJ, Nuyttens J, Paardekooper GMRM, Patijn GA, van der Sangen MJC, de Vos-Geelen J, Wilmink JW, Zwinderman AH, Punt CJ, van Eijck CH, van Tienhoven G, Dutch Pancreatic Cancer Group (2020) Preoperative chemoradiotherapy versus immediate surgery for resectable and borderline resectable pancreatic cancer: results of the dutch randomized phase III PREOPANC trial. J Clin Oncol 38(16):1763–1773. https://doi.org/10.1200/JCO.19.02274
doi: 10.1200/JCO.19.02274
Heinrich S, Besselink M, Moehler M, van Laethem JL, Ducreux M, Grimminger P, Mittler J, Lang H, Lutz MP, Lesurtel M, Scientific and Research Committee of the E-AHPBA and the EORTC pancreas working group (2019) Opinions and use of neoadjuvant therapy for resectable, borderline resectable, and locally advanced pancreatic cancer: international survey and case-vignette study. BMC Cancer 19(1):675. https://doi.org/10.1186/s12885-019-5889-5
doi: 10.1186/s12885-019-5889-5