Diagnosis and management of pancreatic cancer in adults: A summary of guidelines from the UK National Institute for Health and Care Excellence

O’Reilly, Derek; Fou, Linyun; Hasler, Elise; Hawkins, James; O’Çonnell, Susan; Pelone, Ferruccio; Callaway, Mark; Campbell, Fiona; Capel, Margred; Charnley, Richard; Corrie, Pippa; Elliot, Dawn; Goodburn, Lesley; Jewell, Anna; Joharchi, Suzanne; McGeeney, Laura; Mukherjee, Somnath; Oppong, Kofi; Whelan, Philip; Primrose, John; Neoptolemos, John P.

doi:10.1016/j.pan.2018.09.012

Cited by 95 publications

(114 citation statements)

References 13 publications

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“…3 Individuals with pancreatic cancer risk increased more than five-fold may be referred to a familial cancer service for consideration of imaging surveillance, including those with Lynch syndrome or BRCA2 mutation and at least one affected FDR. 5,6 There is no screening test for individuals with standard or mildly increased risk.…”

Section: Risk Factorsmentioning

confidence: 99%

“…14 Positron emission tomography (PET)/CT is increasingly being used to determine staging and may change the treatment plan for up to 20% of patients. 6 Use of PET/CT in this setting varies between institutions and is not currently considered standard care for all cases. Indeterminate extrapancreatic lesions are commonly identified by staging imaging, and it can be unclear whether they represent metastatic disease, a second primary neoplasm or an unrelated benign lesion.…”

Section: Stagingmentioning

confidence: 99%

“…38 All patients with unresectable or metastatic disease require enteric-coated pancreatic enzyme replacement. 6 Enzymes should be considered before and after pancreatic resection. Faecal elastase may be used to determine the level of pancreatic exocrine insufficiency.…”

Section: Nutritional and Pain Managementmentioning

confidence: 99%

“…Coeliac plexus neurolysis should be considered to manage pain. 6 Early referral to palliative care services allows for prompt management of symptoms and provides additional psychological support for the patient and their family.…”

Section: Nutritional and Pain Managementmentioning

confidence: 99%

“…The role of follow-up is to identify new, unexplained or unresolved symptoms that can be further investigated or better managed. 6 However, evidence that surveillance imaging prolongs survival is very weak at best, and therefore no strong recommendations can be made. National Comprehensive Cancer Network guidelines recommend CT scanning and CA 19-9 testing every 3-6 months for two • Pancreatic cancer is categorised as resectable, borderline resectable, locally advanced or metastatic.…”

Section: Prognosis and Follow-upmentioning

confidence: 99%

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Pancreatic cancer: An update on diagnosis and management

Loveday¹,

Lipton

Thomson³

2019

Aust J Gen Pract

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Section: Risk Factorsmentioning

confidence: 99%

Section: Stagingmentioning

confidence: 99%

Section: Nutritional and Pain Managementmentioning

confidence: 99%

Section: Nutritional and Pain Managementmentioning

confidence: 99%

Section: Prognosis and Follow-upmentioning

confidence: 99%

See 3 more Smart Citations

Pancreatic cancer: An update on diagnosis and management

Loveday¹,

Lipton

Thomson³

2019

Aust J Gen Pract

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Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

Andel,

van Goor,

Augustinus

et al. 2024

JAMA Surg

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ImportanceInternational guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.ObjectiveTo compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).Design, Setting, and ParticipantsThis was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.ExposuresSymptomatic follow-up or routine imaging in patients who underwent PDAC resection.Main Outcomes and MeasuresOverall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.ResultsOverall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).Conclusion and RelevanceIn this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

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