A reduced time to surgery within a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy

Roberts, Keith; Prasad, Pooja; Steele, Yvonne; Marcon, Francesca; Faulkner, Thomas C.; Cilliers, Hentie; Dasari, Bobby; Abradelo, M.; Marudanayagam, R.; Sutcliffe, Robert P.; Muiesan, Paolo; Mirza, Darius F.; Isaac, John

doi:10.1016/j.hpb.2017.04.011

Cited by 45 publications

(53 citation statements)

References 29 publications

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“…In August 2015, a pathway to offer surgery without preoperative biliary drainage was implemented at the authors' centre; before this, surgery without preoperative biliary drainage was performed on an ad hoc basis. It is interesting to observe that this reduced the time from CT to referral, suggesting that changes in specialist care pathways influence the behaviour of referring colleagues in non‐specialist centres.…”

Section: Discussionmentioning

confidence: 99%

“…It is interesting to observe that this reduced the time from CT to referral, suggesting that changes in specialist care pathways influence the behaviour of referring colleagues in non‐specialist centres. Patients within this ‘fast track’ pathway were within the shortest quartile in time to surgery where diagnostic and staging investigations were prioritized and organized in parallel, rather than in series, reducing times to diagnosis and treatment. Patients in the longest quartile to surgery were treated within pre‐existing pathways provided within NHS standard treatment times for cancer.…”

Section: Discussionmentioning

confidence: 99%

“…The data were derived from a single hospital and its network of referring teams, and thus may not be generalizable. However, the median time to surgery (61 days) is representative for patients in the UK. There is currently a prospective national audit of pancreatic cancer in the UK, the RICOCHET study, which will map the patient pathway in detail.…”

Section: Discussionmentioning

confidence: 99%

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Evaluation of the clinical and economic impact of delays to surgery in patients with periampullary cancer

et al. 2019

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Background Early treatment is the only potential cure for periampullary cancer. The pathway to surgery is complex and involves multiple procedures across local and specialist hospitals. The aim of this study was to analyse variability within this pathway, and its impact on cost and outcomes. Methods Patients undergoing surgery for periampullary cancer (2011–2016) were identified retrospectively and their pathway to surgery was analysed. Patients who had early surgery (shortest quartile, Q1) were compared with those having late surgery (longest quartile, Q4). Results A total of 483 patients were included in the study, with 121 and 124 patients in Q1 and Q4 respectively. The median time from initial CT to surgery was 21 days for Q1 versus 112 days for Q4 (P < 0·001). Diagnostic delays were common in Q4; these patients required significantly more investigations than those in Q1 (endoscopic ultrasonography (EUS): 74·2 versus 18·2 per cent respectively, P < 0·001; MRI: 33·6 versus 20·6 per cent, P = 0·036). The median time to diagnostic EUS was 13 days in Q1 versus 59 days in Q4 (P < 0·001). Some 42·1 per cent of jaundiced patients in Q1 underwent preoperative biliary drainage, compared with all patients in Q4. There were significantly more unplanned admissions and associated longer duration of hospital stay per patient and costs in Q4 than in Q1 (median: 8 versus 3 days respectively; €5652 versus €2088; both P < 0·001). There was a higher likelihood of potentially curative surgery in Q1 (82·6 per cent versus 66·9 per cent in Q4; P = 0·005). Conclusion There is wide variation across the entire pathway, suggesting that multiple strategies are required to enable early surgery. Defining an effective pathway by anticipating the need for investigations and avoiding biliary drainage reduces unplanned admissions and costs and increases resection rates.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

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Evaluation of the clinical and economic impact of delays to surgery in patients with periampullary cancer

et al. 2019

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“…In this study, the resection rate of the group without preoperative biliary drainage was significantly higher, when compared to that of the not drained group (97 versus 75%). 23 This underlines the importance to perform surgery shortly after the index scan and to repeat radiological imaging when any delay occurs.…”

Section: Discussionmentioning

confidence: 99%

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

Looijen

Pranger

Jong

et al. 2018

Journal of Gastrointestinal Surgery

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Background This study aimed to evaluate the additional value of laparoscopic ultrasound (LUS) to staging laparoscopy (SL) for detecting occult liver metastases in patients with potentially resectable pancreatic head cancer. Methods A retrospective cohort study was performed including all patients who underwent SL and LUS between 2005 and 2016. LUS was performed during SL to detect liver metastases not found by preoperative imaging or visual inspection of the liver. Results Out of 197 patients, visual inspection during SL detected distant metastases in 29 (14.7%) patients. LUS was performed in 127 patients, revealing 3 additional liver metastases. The proportion of patients with unresectable disease after SL and negative LUS was 32.3%, which was similar to 36.6% of patients with unresectable disease after SL without LUS (difference 4.3%; 95% CI − 13-23%; P = 0.61). Sensitivity, specificity, and positive and negative predictive values of LUS to detect liver metastases were 30, 100, 100, and 94%, respectively. The proportion of patients with distant metastases diagnosed at SL significantly increased over time (P = 0.031). Conclusion The routine use of LUS during SL for patients with potentially resectable pancreatic head cancer cannot be recommended. Imaging should be repeated when significant delay occurs between index CT and the scheduled surgery.

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“…1 We aimed to improve the resection rate in our HPB cancer patients referred with jaundice. All referrals are triaged on a daily basis by a Consultant Gastroenterologist.…”

Section: Ptu-090 the Impact Of An Accelerated Pathway For Assessing Jmentioning

confidence: 99%

PTU-089 The clinical effectiveness of the nutrition support team – an acute district general hospital experience

Coyle

Gensale

Finney

et al. 2018

Gastroenterology Service

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A reduced time to surgery within a ‘fast track’ pathway for periampullary malignancy is associated with an increased rate of pancreatoduodenectomy

Cited by 45 publications

References 29 publications

Evaluation of the clinical and economic impact of delays to surgery in patients with periampullary cancer

Evaluation of the clinical and economic impact of delays to surgery in patients with periampullary cancer

The Additional Value of Laparoscopic Ultrasound to Staging Laparoscopy in Patients with Suspected Pancreatic Head Cancer

PTU-089 The clinical effectiveness of the nutrition support team – an acute district general hospital experience

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