Opportunities of improvement in the management of pancreatic and periampullary tumors

Abstract

Objective. The first objective of the present study was to identify opportunities of improvement for clinical practice, assessed by local quality indicators, then to analyze possible reasons why we did not reach defined treatment quality measures. The second objective was to characterize patients, considered unresectable according to present criteria, for future arrangement of interventional studies with improved patient selection.Material and methods.Prospective observational cohort study from October 2008 to December 2010 of patients referred to the authors' institution with suspected pancreatic or periampullary neoplasm.Results.Of 330 patients, 135 underwent surgery, 195 did not, 129 due to unresectable malignancies. The rest had benign lesions. Perioperative morbidity rate was 32.6%, mortality 0.7%. Radical resection (R0) was obtained in 23 (41.8%) of 55 patients operated for pancreatic adenocarcinoma and 6.3% underwent reconstructive vascular surgery. Diagnostic failure/delay resulted in unresectable carcinoma, primarily misconceived as serous cystic adenoma in two patients. One resected lesion turned out to be focal autoimmune pancreatitis. One case with misdiagnosed cancer was revised to be a pseudoaneurysm. Palliative treatment was offered to 144 patients with malignant tumors, 62 due to locally advanced disease and all pancreatic adenocarcinomas.Conclusions.Quality improvement opportunities were identified for patient selection and surgical technique: Too few patients underwent reconstructive vascular surgery. The most important quality indicators are those securing resectional, radical (R0) surgery. Altogether 143 patients (57.9%) of those with malignant tumors were found unresectable, most of these patients are eligible for inclusion in future interventional studies with curative and/or palliative intention.

Preoperative cognitive function predicts survival in patients with resectable pancreatic ductal adenocarcinoma

“…1b). Patients with low cognitive function and those with high cognitive function had a median overall survival of 10 [95% CI 6-16] and 21 [95% CI [16][17][18][19][20][21][22][23][24][25][26][27][28][29][30] months respectively (Fig. 1c).…”

“…In October 2008, Oslo University Hospital established a multidisciplinary research program, Thematic Pancreatic Tumour Project (TPTP), on pancreatic tumours including all patients who were referred with solid or cystic pancreatic or periampullary tumours. 19 A database was established containing a prospective sampling of PROs such as symptoms, functioning and HRQoL. Patients undergoing a potentially curative resection for PDAC were identified from the database.…”

Survival, Complications and Patient Reported Outcomes after Pancreatic Surgery

“…Preoperative work-up/treatment All patients underwent evaluation at the multidisciplinary meeting, as described previously. 11 Preoperative workup included multidetector computed tomography (CT) with a standard protocol optimized for imaging pancreatic tumours, and chest CT. Tumours infiltrating the superior mesenteric vein (SMV) or portal vein (PV) were considered resectable if there was a patent vein above and below the infiltrated site to allow reconstruction. 12,13 Preoperative histological diagnosis was not required.…”

Trends in management and outcome of cystic pancreatic lesions – analysis of 322 cases undergoing surgical resection

“…During the whole study period the two hospitals had a formal collaboration and laparoscopic distal pancreatic resections were performed at Rikshospitalet. Decision-making by a multidisciplinary team (MDT) for pancreatic tumours was performed routinely throughout the whole study period, but for CPL a more systematic approach was initiated in 2008 [19]. From 2013 and onward, the ECG was adopted [1].…”