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14-11-2022 | Pancreatoduodenostomy | Original Article

Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study

Authors: Jose M. Ramia, Esteban Cugat, Roberto De la Plaza, Miguel A. Gomez-Bravo, Elena Martín, Luis Muñoz-Bellvis, Francisco J. Padillo, Luis Sabater, Mario Serradilla-Martín

Published in: Updates in Surgery | Issue 1/2023

Abstract

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.

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Title: Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study
Authors: Jose M. Ramia
Esteban Cugat
Roberto De la Plaza
Miguel A. Gomez-Bravo
Elena Martín
Luis Muñoz-Bellvis
Francisco J. Padillo
Luis Sabater
Mario Serradilla-Martín
Publication date: 14-11-2022
Publisher: Springer International Publishing
Keywords: Pancreatoduodenostomy
Pancreatic Surgery
Pancreatic Surgery
Pancreatoduodenostomy
Pancreatic Cancer
Pancreatic Cancer
Published in: Updates in Surgery / Issue 1/2023
Print ISSN: 2038-131X
Electronic ISSN: 2038-3312
DOI: https://doi.org/10.1007/s13304-022-01415-1

Keynote webinar | Spotlight on medication adherence

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Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study

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