Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Geest, Lydia G. M. van der; Lemmens, Valery; Hingh, Ignace H. J. T. de; Laarhoven, Cees J. H. M. van; Bollen, Thomas L.; Nio, C. Yung; Eijck, Casper H.J. van; Busch, O.; Besselink, Marc G.

doi:10.1002/bjs.10602

Cited by 40 publications

(21 citation statements)

References 43 publications

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“…Our study revealed that the NRR did not decrease during the last 2 decades among patients with PDAC entering the operating room for an intention-to-cure pancreatectomy. The observed overall NRR of 24.5% was consistent with those of previously reported series among patients diagnosed with PDAC [ 12 ].…”

Section: Discussionsupporting

confidence: 91%

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

et al. 2020

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Purpose: To determine if improvement in imaging reduces the non-resection rate (NRR) among patients with pancreatic ductal adenocarcinoma (PDAC). Methods: From 2000 to 2019, 751 consecutive patients with PDAC were considered eligible for a intention-to-treat pancreatectomy and entered the operating room. In April 2011, our institution acquired a dual energy spectral computed tomography (CT) scanner and liver diffusion weighted magnetic resonance imaging (DW-MRI) was included in the imaging workup. We consequently considered 2 periods of inclusion: period #1 (February 2000-March 2011) and period #2 (April 2011-August 2019). Results: All patients underwent a preoperative CT scan with a median delay to surgery of 18 days. Liver DW-MRI was performed among 407 patients (54%). Median delay between CT and surgery decreased (21 days to 16 days, P < .01), and liver DW-MRI was significantly most prescribed during period #2 (14% vs 75%, P < .01). According to the intraoperative findings, the overall NRR was 24.5%, and remained stable over the two periods (25% vs 24%, respectively). While vascular invasion, liver metastasis, and carcinomatosis rates remained stable, para-aortic lymph nodes invasion rate (0.4% vs 4.6%; P < 0.001) significantly increased over the 2 periods. The mean size of the bigger extra pancreatic tumor significantly decrease (7.9 mm vs 6.4 mm (P < .01), respectively) when the resection was not done. In multivariate analysis, CA 19-9 < 500 U/mL (P < .01), and liver DW-MRI prescription (P < .01) favoured the resection. Conclusions: Due to changes in our therapeutic strategies, the NRR did not decrease during two decades despite imaging improvement.

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Section: Discussionsupporting

confidence: 91%

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

et al. 2020

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“…The higher mortality rates among the unresectable group in comparison to the resectable group were expected. A high 30-day mortality was also seen in a cohort including only pancreatic cancer patients 12 . Having an unresectable tumor indicates a more disseminated disease, which should impact the expected survival negatively.…”

Section: Discussionmentioning

confidence: 82%

“…Among patients who underwent surgical exploration, the proportion of patients with tumor resection did not increase. In an article including only pancreatic cancer patients, an increased resection rate was seen comparing 2009 and 2013, but still almost one-third of patients with surgical exploration for pancreatic cancer did not undergo resection 12 . During the last years, a centralization of pancreatic surgery has been completed in many countries and the sensitivity of preoperative imaging has been improving 9 , 12 , 19 .…”

Section: Discussionmentioning

confidence: 99%

Surgical exploration without resection in pancreatic and periampullary tumors: Report from a national database

et al. 2020

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Background and Aims: Pancreatic and periampullary cancers are sometimes found to have a too advanced disease during surgery to allow resection. The aim was to describe characteristics, treatment, outcome, and time trends for patients that were planned for pancreatic surgery but found unresectable during surgery. Material and Methods: Data from the Swedish National Pancreatic and Periampullary Cancer Registry were used. All patients registered between January 2010 and August 2018 were included. The patient cohort was divided in two halves based on year of diagnosis. Results: In total, 12,377 patients were included in the registry and finally 4568 patients were scheduled for surgery. During surgical exploration, 3879 (84.9%) patients underwent pancreatic resection, 658 (14.4%) patients were found unresectable, and 31 (0.7%) had no pancreatic resection due to other reasons (e.g. benign lesion, comorbidity). More patients underwent surgical exploration and resection during the second time period, but exploration without resection was unchanged (15.7% vs 13.7%; p = 0.062). Survival rates were lower among the unresectable patients with pancreatic and periampullary tumors compared to the resectable patients, including 30-day mortality (n = 17 (3.5%) vs n = 39 (1.6%), p = 0.004) and 90-day mortality (n = 72 (15.0%) vs n = 70 (2.8%), p < 0.001). Palliative surgery became less common during the second half of the time period (p < 0.001). Conclusion: Unresectability is associated with an unfavorable prognosis. The frequency did not decrease during the study period, but palliative surgical procedures became less common.

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“…Studies confirm that compliance with only a few elements of those protocols results in fewer benefits for outcome improvement. CHO loading, early nutrition support and avoiding fluid overload are key factors contributing to the decreased length of hospital stay, number of postoperative complications and readmission rates in abdominal surgery [ 67 , 68 , 69 ].…”

Section: Discussionmentioning

confidence: 99%

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

et al. 2020

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Background and aim: Preoperative fasting leads to metabolic stress and causes insulin resistance in patients undergoing cardiac surgery. The aim of this study was to assess the effect of preoperative oral carbohydrate loading (OCH) on outcome in patients undergoing planned cardiac surgery by systematically reviewing the literature and synthesizing evidence from randomized controlled trials (RCTs). Methods: Systematic search of PubMed/MEDLINE/Embase/Cinahl/Web of Science/ClinicalTrials databases was performed to identify relevant RCTs from databased inception until 05/03/2020. We included studies that compared outcome measures between OCH with control (placebo or standard starvation). We conducted a random-effect meta-analysis of clinical and biochemical parameters. Results: Nine studies (N = 9) were included with a total of 507 patients. OCH significantly decreased aortic clamping duration (n = 151, standardized mean difference (SMD) = −0.28, 95% confidence interval (CI) = −0.521 to −0.038, p = 0.023 and differences in means (DM) = −6.388, 95%CI = −11.246 to −1.529, p = 0.010). Patients from treatment groups had shorter intensive care unit (ICU) stay (n = 202, SMD = −0.542, 95%CI = −0.789 to −0.295, p < 0.001 and DM = −25.925, 95%CI = −44.568 to −7.283, p = 0.006) and required fewer units of insulin postoperatively (n = 85, SMD = −0.349, 95%CI = −0.653 to −0.044, p = 0.025 and DM = −4.523, 95%CI = −8.417 to −0.630, p = 0.023). The necessity to use inotropic drugs was significantly lower in the OCH group (risk ratio (RR) = 0.795, 95%CI = 0.689 to 0.919, p = 0.002). All other primary outcomes did not reveal a significant effect. Conclusions: Preoperative OCH in patients undergoing cardiac surgery demonstrated a 20% reduction in the use of inotropic drugs, a 50% reduction of the length of ICU stay, a 28% decrease in aortic clamping duration and a 35% decrease of postoperative insulin requirement.

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Nationwide outcomes in patients undergoing surgical exploration without resection for pancreatic cancer

Abstract: Exploration and resection rates increased, but one-third of patients who had surgical exploration for pancreatic cancer did not undergo resection. Non-resectional surgery doubled the 30-day mortality rate compared with that in patients undergoing tumour resection.

Cited by 40 publications

References 43 publications

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

Has the non-resection rate decreased during the last two decades among patients undergoing surgical exploration for pancreatic adenocarcinoma?

Surgical exploration without resection in pancreatic and periampullary tumors: Report from a national database

The Effect of Preoperative Carbohydrate Loading on Clinical and Biochemical Outcomes after Cardiac Surgery: A Systematic Review and Meta-Analysis of Randomized Trials

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