21 (34.4%) patients were found to be surgically inoperable either due to metastasis or local unresectability after laparotomy. If CECT was considered as a sole diagnostic modality, 27 (40.3%) patients would have been surgically inoperable. Among those patients who were deemed operable by PET-CT, DL detected inoperability in 9 patients (14.7%) (peritoneal 8, omental 6, and liver 3). Laparotomy was performed in the DL-wise operable patients (N¼52) and 12 (23.08%) patients were found to be inoperable due to local invasion. Hence the FNR of CECT, PET-CT, and DL in detecting the inoperability was 40.3%,34.4%, and 23.1%, respectively. Out of the 27 patients who were surgically inoperable, DL detected inoperability and futile laparotomies were avoided in 9 patients. The actual rate would have further increased to 15/ 27(55.5%) if the PET-CT detected metastasis (6 patients) were subjected to DL. On univariate analysis, size of the GB mass in CECT significantly correlated with PET-CT detected inoperability (p value ¼ 0.006; Odds ratio 1.64; CI 1.09 to 2.47). The sensitivity, specificity, PPV and NPV of CECT and PET-CT in detecting the lymph node involvement in operable GBC patients were 14.3%, 82.2%, 11.1%, 86% and 57.1%, 79.1%, 30.8%, 86.1%, respectively. Conclusion:Diagnostic laparoscopy obviated futile laparotomies by more than half (55.5%) of unresectable patients and 22.38% in overall patients. Hence DL should be performed in all the operable GBC patients before surgery. PET-CT can be selectively done in patients with larger GB masses in CECT (>1cm). Though PET-CT is more sensitive compared to CECT, both are not an accurate modality in detecting the lymph node involvement in the case of GBC.

RESUMO Objetivo: as recomendações das decisões em Tumor Board (TB) deveriam ser acompanhadas para identificar barreiras que possam interferir na execução do melhor cuidado para o paciente decidido previamente. O objetivo do estudo é avaliar se a decisão de conduta em TB foi realizada em pacientes com tumores pancreáticos, o status de vida 90 dias após TB e analisar os motivos pelos quais a conduta não foi realizada. Métodos: estudo retrospectivo com pacientes com tumores de pâncreas, avaliados entre 2017 a 2019. Dados epidemiológicos, se a conduta de TB foi realizada, o motivo da não realização, o status de vida em 90 dias após decisão de TB e quantas vezes cada paciente foi discutido em reunião foram coletados. As variáveis categóricas foram comparadas pelo teste de qui-quadrado; variáveis numéricas foram apresentadas como médias e desvio padrão. Resultados: 111 casos, 95 pacientes, 86 (90,5%) com diagnóstico de câncer. Após 90 dias de TB, 83 pacientes (87,37%) permaneceram vivos, 9 pacientes (9,47%) faleceram e 3 (3,16%) perderam o seguimento. A conduta do TB não foi realizada em 12 (10,8%) dos casos e os motivos foram: 25% (3) por perda de seguimento, 8,33% (1) por recusa do paciente e 66,67% (8) devido à piora clínica. Os casos de pacientes com metástases tiveram menor execução de conduta de TB (p=0,006). Conclusões: a conduta do TB é realizada na maior parte dos casos e o motivo mais evidente para o não cumprimento das condutas é a piora clínica do paciente.

Objective: the recommendations of the decisions made by the Tumor Board (TB) should be followed to identify barriers that may interfere with the execution of the previously decided, best care for the patient. The aim of this study is to assess whether the TB conduct decision was performed in patients with pancreatic tumors, their life status 90 days after the TB decision, and to analyze the reasons why the conduct was not performed. Methods: we conducted a retrospective study with patients with pancreas tumors, evaluated between 2017 and 2019. We collected data on epidemiological status, whether the TB procedure was performed, the reason for not performing it, life status 90 days after the TB decision, and how many times each patient was discussed at a meeting. We compared categorical variables using the chi square test, numerical variables were presented as means and standard deviation. Results: we studied 111 session cases, in 95 patients, 86 (90.5%) diagnosed with cancer. After 90 days of TB, 83 patients (87.37%) remained alive, 9 had (9.47%) died, and 3 (3.16%) were lost to follow-up. The TB decision was not observed in 12 (10.8%) cases and the reasons were: 25% (3) for loss of follow-up, 8.33% (1) for patient refusal, and 66.67% (8) due to clinical worsening. The cases of patients with metastases had a lower rate of TB conduct compliance (p=0.006). Conclusions: the TB conduct was performed in most cases and the most evident reason for non-compliance with the conducts is the patient’s clinical worsening.