No abstract

Pancreaticoduodenectomy has become a commonly performed operation in many tertiary care centers. Operative time, blood loss, and length of stay have dropped substantially. The operation has become safe, with a low hospital mortality. It has become an effective operation for pancreatic cancer in those patients in whom their tumor is margin negative and node negative.

This series represents the largest single institution experience reporting the perioperative management of BDI following LC. Although perioperative complications are frequent, nearly all can be managed nonoperatively. Early referral to a tertiary care center with experienced hepatobiliary surgeons and skilled interventional radiologists would appear to be necessary to assure optimal results.

Adjuvant chemoradiation therapy significantly improves survival after pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Based on these survival data, standard adjuvant chemoradiation therapy appears to be indicated for patients treated by pancreaticoduodenectomy for adenocarcinoma of the head, neck, or uncinate process of the pancreas. Intensive therapy conferred no survival advantage over standard therapy in this analysis.

Purpose-To evaluate the impact of a multidisciplinary clinic on the clinical care recommendations of patients with pancreatic cancer compared with the recommendations the patients received prior to review by the multidisciplinary tumor board.Methods-The records of 203 consecutive patients referred to the Johns Hopkins pancreatic multidisciplinary clinic were prospectively collected from November 2006 to October 2007. Crosssectional imaging, pathology, and medical history were evaluated by a panel of medical/radiation oncologists, surgical oncologists, pathologists, diagnostic radiologists, and geneticists. Alterations in treatment recommendations between the outside institution and the multidisciplinary clinic were recorded and compared.Results-On presentation, the outside computed tomography (CT) report described locally advanced/unresectable disease (34.9%), metastatic disease (17.7%), and locally advanced disease with metastasis (1.1%). On review of submitted imaging and imaging performed at Hopkins, 38 out of 203 (18.7%) NIH Public Access Author ManuscriptAnn Surg Oncol. Author manuscript; available in PMC 2010 July 20. Conclusion-The single-day pancreatic multidisciplinary clinic provided a comprehensive and coordinated evaluation of patients that led to changes in therapeutic recommendations in close to one-quarter of patients. KeywordsMultidisciplinary; Pancreas; Cancer; OutcomeAs the care of patients with cancer has become more complex, fewer patients are being treated with single-modality therapy. Rather, most patients with cancer are now cared for using a combination of surgery, chemotherapy, and/or radiation therapy. As such, multidisciplinary cancer clinics have become increasingly prevalent in the management of patients with malignancies. Multidisciplinary clinics allow specialists to work together to develop consensus recommendations in accordance with guidelines and protocols endorsed by the clinical team. 1 Over time, multidisciplinary care has become accepted as the optimal mechanism for delivering care in oncology. [1][2][3] In the USA, both the Commission on Cancer and the American College of Surgeons require multidisciplinary cancer conferences for the accreditation of health centers delivering multidisciplinary care. [3][4][5] Although multidisciplinary care has widely been endorsed and accepted, the impact of formal multidisciplinary clinics has yet to be established. In fact, little qualitative and quantitative research exists to determine the impact of multidisciplinary clinics on patient outcomes.6 Data on the effect of multidisciplinary clinics on patient outcomes are clearly important, as these clinics require a substantial amount of clinical and institutional resources. While improved outcomes in breast cancer patients treated at multidisciplinary clinics have been documented, 7 , 8 no such data exist for patients with gastrointestinal malignancies. Specifically, the impact of multidisciplinary clinics to treat patients with pancreatic cancer has not been previously documen...