Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster-randomized trial

Smits, F. Jasmijn; Henry, Anne Claire; Eijck, Casper H. van; Besselink, Marc G.; Busch, Olivier R.; Arntz, Mark; Bollen, Thomas L.; Delden, Otto M. van; Heuvel, D. Van Den; Leij, Christiaan van der; Lienden, Krijn P. van; Moelker, Adriaan; Bonsing, Bert A.; Rinkes, Inne H.M. Borel; Bosscha, K.; Dam, Ronald M. van; Festen, Sebastiaan; Koerkamp, Bas Groot; Harst, Erwin van der; Hingh, Ignace H. J. T. de; Kazemier, Geert; Liem, Mike S L; Kolk, B.M. van der; Meijer, Vincent E de; Patijn, Gijs A.; Roos, Daphne; Schreinemakers, Jennifer M. J.; Wit, Fennie; Werkhoven, Cornelis H. van; Molenaar, I.; Santvoort, Hjalmar C. van

doi:10.1186/s13063-020-4167-9

Cited by 25 publications

(7 citation statements)

References 46 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…PORSCH, PREOPANC-1 and -2 and PACAP-1 trials). 28 , 30 , 31 , 32 , 33 , 35 Therefore, interpretations of the results must be made with caution. The main strength of this study is the use of nationwide, population-based data from the NCR for all adult patients diagnosed with pancreatic cancer.…”

Section: Discussionmentioning

confidence: 99%

Population-based impact of COVID-19 on incidence, treatment, and survival of patients with pancreatic cancer

Graus¹,

Hingh²,

Besselink³

et al. 2023

HPB

Self Cite

View full text Add to dashboard Cite

Section: Discussionmentioning

confidence: 99%

Population-based impact of COVID-19 on incidence, treatment, and survival of patients with pancreatic cancer

Graus¹,

Hingh²,

Besselink³

et al. 2023

HPB

Self Cite

View full text Add to dashboard Cite

“…Such a protocol has recently been implemented during the nationwide PORSCH trial, which included patients with duodenal adenocarcinoma and reduced mortality after pancreatic surgery. 37 Fifth, no data on adjuvant chemotherapy were available. Major morbidity could influence the rate of adjuvant chemotherapy, for instance, in patients with positive nodal status.…”

Section: Discussionmentioning

confidence: 99%

Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study

et al. 2022

Self Cite

View full text Add to dashboard Cite

Background Surgical outcome after pancreatoduodenectomy for duodenal adenocarcinoma could differ from pancreatoduodenectomy for other cancers, but large multicenter series are lacking. This study aimed to determine surgical outcome in patients after pancreatoduodenectomy for duodenal adenocarcinoma, compared with other periampullary cancers, in a nationwide multicenter cohort. Methods After pancreatoduodenectomy for cancer between 2014 and 2019, consecutive patients were included from the nationwide, mandatory Dutch Pancreatic Cancer Audit. Patients were stratified by diagnosis. Baseline, treatment characteristics, and postoperative outcome were compared between groups. The association between diagnosis and major complications (Clavien–Dindo grade III or higher) was assessed via multivariable regression analysis. Results Overall, 3113 patients, after pancreatoduodenectomy for cancer, were included in this study: 264 (8.5%) patients with duodenal adenocarcinomas and 2849 (91.5%) with other cancers. After pancreatoduodenectomy for duodenal adenocarcinoma, patients had higher rates of major complications (42.8% vs. 28.6%; p < 0.001), postoperative pancreatic fistula (International Study Group of Pancreatic Surgery [ISGPS] grade B/C; 23.1% vs. 13.4%; p < 0.001), complication-related intensive care admission (14.3% vs. 10.3%; p = 0.046), re-interventions (39.8% vs. 26.6%; p < 0.001), in-hospital mortality (5.7% vs. 3.1%; p = 0.025), and longer hospital stay (15 days vs. 11 days; p < 0.001) compared with pancreatoduodenectomy for other cancers. In multivariable analysis, duodenal adenocarcinoma was independently associated with major complications (odds ratio 1.14, 95% confidence interval 1.03–1.27; p = 0.011). Conclusion Pancreatoduodenectomy for duodenal adenocarcinoma is associated with higher rates of major complications, pancreatic fistula, re-interventions, and in-hospital mortality compared with patients undergoing pancreatoduodenectomy for other cancers. These findings should be considered in patient counseling and postoperative management.

show abstract

“…Early detection and treatment of complications might prevent worsening of severity of complications. In 2018, the DPCG started the PORSCH trial, a nationwide stepped-wedge cluster randomized trial [ 15 ]. The aim of this trial was to evaluate if implementation of a best-practice algorithm for postoperative care focusing on early detection and step-up management of POPF could result in a lower rate of major complications and mortality after pancreatic resection, as compared to the current practice.…”

Section: Discussionmentioning

confidence: 99%

The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

Linnemann

Kooijman

Hilst

et al. 2021

Cancers

View full text Add to dashboard Cite

Background/Objectives: Complications after pancreatoduodenectomy (PD) lead to unplanned readmissions (UR), with a two- to threefold increase in admission costs. In this study, we aimed to create an understanding of the costs of complications and UR in this patient group. Furthermore, we aimed to generate a detailed cost overview that can be used to build a theoretical model to calculate the cost efficacy for prehabilitation. Methods: A retrospective cohort analysis was performed using the Dutch Pancreatic Cancer Audit (DPCA) database of patients who underwent a PD at our institute between 2013 and 2017. The total costs of the index hospital admission and UR related to the PD were collected. Results: Of the 160 patients; 35 patients (22%) had an uncomplicated course; 87 patients (54%) had minor complications, and 38 patients (24%) had severe complications. Median costs for an uncomplicated course were EUR 25.682, and for a complicated course, EUR 32.958 (p = 0.001). The median costs for minor complications were EUR 30.316, and for major complications, EUR 42.664 (p = 0.001). Costs were related to the Comprehensive Complication Index (CCI). The median costs of patients with one or more UR were EUR 41.199. Conclusions: Complications after PD led to a EUR 4.634–EUR 16.982 (18–66%) increase in hospital costs. A UR led to a cost increase of EUR 12.567 (44%). Since hospital costs are directly related to the CCI, reduction in complications will lead to cost-effectiveness.

show abstract

Care after pancreatic resection according to an algorithm for early detection and minimally invasive management of pancreatic fistula versus current practice (PORSCH-trial): design and rationale of a nationwide stepped-wedge cluster-randomized trial

Cited by 25 publications

References 46 publications

Population-based impact of COVID-19 on incidence, treatment, and survival of patients with pancreatic cancer

Population-based impact of COVID-19 on incidence, treatment, and survival of patients with pancreatic cancer

Surgical Outcome After Pancreatoduodenectomy for Duodenal Adenocarcinoma Compared with Other Periampullary Cancers: A Nationwide Audit Study

The Costs of Complications and Unplanned Readmissions after Pancreatoduodenectomy for Pancreatic and Periampullary Tumors: Results from a Single Academic Center

Contact Info

Product

Resources

About