Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies

Roessel, Stijn van; Mackay, Tara M; Tol, Johanna A. M. G.; Delden, Otto M. van; Lienden, Krijn P. van; Nio, C. Yung; Phoa, Saffire S.K.S.; Fockens, Paul; Hooft, Jeanin E. van; Verheij, Joanne; Wilmink, Johanna W.; Gulik, Thomas M. van; Gouma, Dirk J.; Busch, Olivier R.; Besselink, Marc G.

doi:10.1016/j.hpb.2018.10.020

Cited by 25 publications

(17 citation statements)

References 52 publications

Supporting

Mentioning

Contrasting

Order By: Relevance

“…The incidence of pancreatic ductal adenocarcinoma and periampullary cancer has increased over the past two decades, resulting in increasing numbers of patients amenable for cancer-directed treatment 1 . Pancreatic surgery in combination with systemic chemotherapy provides the best outlook for long-term survival, but is associated with a relatively high risk of complications [2][3][4] . Studies [5][6][7] have demonstrated a clear relationship between hospital volume and postoperative mortality.…”

Section: Introductionmentioning

confidence: 99%

Effect of centralization and regionalization of pancreatic surgery on resection rates and survival

Latenstein

Mackay

Geest

et al. 2021

British Journal of Surgery

View full text Add to dashboard Cite

Background Centralization of pancreatic surgery in the Netherlands has been ongoing since 2011. The aim of this study was to assess how centralization has affected the likelihood of resection and survival of patients with non-metastatic pancreatic head and periampullary cancer, diagnosed in hospitals with and without pancreatic surgery services. Methods An observational cohort study was performed on nationwide data from the Netherlands Cancer Registry (2009–2017), including patients diagnosed with non-metastatic pancreatic head or periampullary cancer. The period of diagnosis was divided into three time intervals: 2009–2011, 2012–2014 and 2015–2017. Hospital of diagnosis was classified as a pancreatic or non-pancreatic surgery centre. Analyses were performed using multivariable logistic and Cox regression models. Results In total, 10 079 patients were included, of whom 3114 (30.9 per cent) were diagnosed in pancreatic surgery centres. Between 2009–2011 and 2015–2017, the number of patients undergoing resection increased from 1267 of 3169 (40.0 per cent) to 1705 of 3566 (47.8 per cent) (P for trend < 0.001). In multivariable analysis, in 2015–2017, unlike the previous periods, patients diagnosed in pancreatic and non-pancreatic surgery centres had a similar likelihood of resection (odds ratio 1.08, 95 per cent c.i. 0.90 to 1.28; P = 0.422). In this period, however, overall survival was higher in patients diagnosed in pancreatic surgery than in those diagnosed in non-pancreatic surgery centres (hazard ratio 0.92, 95 per cent c.i. 0.85 to 0.99; P = 0.047). Conclusion After centralization of pancreatic surgery, the resection rate for patients with pancreatic head and periampullary cancer diagnosed in non-pancreatic surgery centres increased and became similar to that in pancreatic surgery centres. Overall survival remained higher in patients diagnosed in pancreatic surgery centres.

show abstract

Section: Introductionmentioning

confidence: 99%

Effect of centralization and regionalization of pancreatic surgery on resection rates and survival

Latenstein

Mackay

Geest

et al. 2021

British Journal of Surgery

View full text Add to dashboard Cite

show abstract

“…Several studies have shown an increase of VR over the time, indicating that there should be sufficient exposure in the training program of pancreatoduodenectomy surgeons. [36][37][38] Most surgeons thought that Type 4 reconstruction carried the highest risk of complications. Several studies about association between type of VR and complications exist.…”

Section: Discussionmentioning

confidence: 99%

Surgical management and pathological assessment of pancreatoduodenectomy with venous resection: an international survey among surgeons and pathologists

Groen

Stommel

Sarasqueta

et al. 2021

HPB

Self Cite

View full text Add to dashboard Cite

Background: The aim of this survey was to gain insights in the current surgical management and pathological assessment of pancreatoduodenectomy with portal-superior mesenteric vein resection (VR). Methods: A systematic literature search was performed to identify international expert surgeons (N = 150) and pathologists (N = 40) who published relevant studies between 2009 and 2019. These experts and Dutch surgeons (N = 17) and pathologists (N = 20) were approached to complete an online survey. Results: Overall, 76 (46%) surgeons and 37 (62%) pathologists completed the survey. Most surgeons (71%) estimated that preoperative imaging corresponded correctly with intraoperative findings of venous involvement in 50-75% of patients. An increased complication risk following VR was expected by 55% of surgeons, mainly after Type 4 (segmental resection-venous conduit anastomosis). Most surgeons (61%) preferred Type 3 (segmental resection-primary anastomosis). Most surgeons (75%) always perform the VR themselves. Standard postoperative imaging for patency control was performed by 54% of surgeons and 39% adjusted thromboprophylaxis following VR. Most pathologists (76%) always assessed tumor infiltration in the resected vein and only 54% of pathologists always assess the resection margins of the vein itself. Variation in assessment of tumor infiltration depth was observed. Conclusion: This international survey showed variation in the surgical management and pathological assessment of pancreatoduodenectomy with venous involvement. This highlights the lack of evidence and emphasizes the need for research on imaging modalities to improve patient selection for VR, surgical techniques, postoperative management and standardization of the pathological assessment.

show abstract

“…pancreascalculator.com. A systematic review including 9 monocenter series of at least 500 consecutive PDs, 19 found a rate of DGE of 8.6%-18.0% in studies with PD performed for all indications. [20][21][22][23][24][25] The rate of DGE grade B/C after PD in this cohort was 26.9% and thus on the higher side of this range.…”

Section: Discussionmentioning

confidence: 99%

Hospital costs of delayed gastric emptying following pancreatoduodenectomy and the financial headroom for novel prophylactic treatment strategies

Francken

Roessel

Swijnenburg

et al. 2021

HPB

Self Cite

View full text Add to dashboard Cite

Background: Delayed gastric emptying (DGE) is one of the most common complications following pancreatoduodenectomy (PD). In-hospital costs of DGE are unknown as well as the financial headroom for novel prophylactic treatments. This retrospective study aims to estimate the hospital costs of DGE and model the financial headroom per patient for new prophylactic treatment strategies within budget. Q8 Methods: Retrospective analysis of a single-center prospective database including patients after PD (2010-2017). In-hospital costs for clinically relevant DGE (ISGPS grade B/C) were calculated by comparing patient groups with and without DGE or other complications. The financial headroom per patient was modelled for potential reductions (0-100%) of empirical DGE baseline risks (15-30%). Results: Overall, DGE was present in 156 (26.9%) of 581 patients after PD. Costs for patients with isolated DGE (n = 90) were V10 295 higher than for patients without complications (n = 333). Costs for patients with other complications including DGE (n = 66) were V9008 higher than for patients with other complications without DGE (n = 92). The financial headroom for a novel prophylactic treatment per patient undergoing PD was V975 per 10% absolute decrease of DGE risk. Discussion: Hospital costs of DGE after PD are substantial. The financial headroom per patient for new DGE prophylactic treatments can be easily calculated via www.pancreascalculator.com.

show abstract

Impact of expanding indications on surgical and oncological outcome in 1434 consecutive pancreatoduodenectomies

Cited by 25 publications

References 52 publications

Effect of centralization and regionalization of pancreatic surgery on resection rates and survival

Effect of centralization and regionalization of pancreatic surgery on resection rates and survival

Surgical management and pathological assessment of pancreatoduodenectomy with venous resection: an international survey among surgeons and pathologists

Hospital costs of delayed gastric emptying following pancreatoduodenectomy and the financial headroom for novel prophylactic treatment strategies

Contact Info

Product

Resources

About