Transatlantic registries of pancreatic surgery in the United States of America, Germany, the Netherlands, and Sweden: Comparing design, variables, patients, treatment strategies, and outcomes

Mackay, Tara M; Gleeson, Elizabeth M.; Wellner, Ulrich F.; Williamsson, Caroline; Busch, Olivier R.; Koerkamp, Bas Groot; Keck, Tobias; Santvoort, Hjalmar C. van; Tingstedt, Bobby; Pitt, Henry A.; Besselink, Marc G.

doi:10.1016/j.surg.2020.07.012

Cited by 44 publications

(55 citation statements)

References 24 publications

(20 reference statements)

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“…As concluded in the previous comparison between these 4 registries, implementation of key parameters with identical definitions in the separate registries is required. 8 The Dutch and Swedish registries are nationwide with very high coverage, whereas the NSQIP and German StuDoQ registries are multicenter with a two-third and one-fifth nationwide coverage, respectively. The NQSIP has a high presence of high-volume centers, which could partly explain the high rate of neoadjuvant therapy and improved postoperative outcomes in the United States.…”

Section: Discussionmentioning

confidence: 99%

“…Similar to our analyses of patients who underwent PD, Germany had the highest reoperation rate. 8 The high reoperation rate was surprising given the fact that no pancreatic fistula would have been present after surgery, and it is common practice to use a step-up approach before performing a reoperation. Other complications such as postpancreatectomy hemorrhage, bile leak, and organ space surgical site infections are potential indications for reoperation.…”

Section: Discussionmentioning

confidence: 99%

“…Baseline characteristics and postoperative and pathological outcomes were collected according to the previously described methods for the comparison of pancreatoduodenectomies (PDs) from the 4 registries by this study group. 8 The use of TP per country/registry was assessed by calculating the ratio of TP to PD. Postoperative outcomes were registered during initial hospital admission, until 30 days after surgery, or until discharge if longer than 30 days.…”

Section: Data Collectionmentioning

confidence: 99%

“…A previous comparison of 20,000 pancreatoduodenectomies from 4 Western registries demonstrated considerable differences in patient and tumor characteristics in the period 2014 to 2017. 8 It is unclear to what extent such differences also exist between patients undergoing TP.…”

Section: Introductionmentioning

confidence: 99%

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The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Latenstein

Mackay

Beane³

et al. 2021

Surgery

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Background: Total pancreatectomy has high morbidity and mortality and differences among countries are currently unknown. This study compared the use and postoperative outcomes of total pancreatectomy among 4 Western countries. Methods: Patients who underwent one-stage total pancreatectomy were included from registries in the United States, Germany, the Netherlands, and Sweden (2014e2018). Use of total pancreatectomy was assessed by calculating the ratio total pancreatectomy to pancreatoduodenectomy. Primary outcomes were major morbidity (Clavien Dindo 3) and in-hospital mortality. Predictors for the primary outcomes were assessed in multivariable logistic regression analyses. Sensitivity analysis assessed the impact of volume (low-volume <40 or high-volume 40 pancreatoduodenectomies annually; data available for the Netherlands and Germany). Results: In total, 1,579 patients underwent one-stage total pancreatectomy. The relative use of total pancreatectomy to pancreatoduodenectomy varied up to fivefold (United States 0.03, Germany 0.15, the Netherlands 0.03, and Sweden 0.15; P < .001). Both the indication and several baseline characteristics differed significantly among countries. Major morbidity occurred in 423 patients (26.8%) and differed (22.3%, 34.9%, 38.3%, and 15.9%, respectively; P < .001). In-hospital mortality occurred in 85 patients (5.4%) and also differed (1.8%, 10.2%, 10.8%, 1.9%, respectively; P < .001). Country, age 75, and vascular resection were predictors for in-hospital mortality. In-hospital mortality was lower in high-volume centers in the Netherlands (4.9% vs 23.1%; P ¼ .002), but not in Germany (9.8% vs 10.6%; P ¼ .733). Conclusion: Considerable differences in the use of total pancreatectomy, patient characteristics, and postoperative outcome were noted among 4 Western countries with better outcomes in the United States and Sweden. These large, yet unexplained, differences require further research to ultimately improve patient outcome.

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Section: Discussionmentioning

confidence: 99%

Section: Discussionmentioning

confidence: 99%

Section: Data Collectionmentioning

confidence: 99%

Section: Introductionmentioning

confidence: 99%

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The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Latenstein

Mackay

Beane³

et al. 2021

Surgery

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“…Upfront surgery is still, by far, the most frequently adopted approach for localized pancreatic cancer in both the USA and Europe, even though large retrospective studies ( 3 , 4 ) and a few randomized controlled trials (RCTs) ( 5 , 6 ) have observed prognostic improvements with neoadjuvant treatments. A recent paper analyzing national registries in the USA and in some European countries demonstrated that from 2014 to 2017, the rate of pancreatic cancer patients receiving preoperative chemotherapy was 27.6% in the USA, 4.9% in Germany, 7.0% in the Netherlands, and 3.4% in Sweden ( 7 ).…”

Section: Introductionmentioning

confidence: 99%

Prognosis of Upfront Surgery for Pancreatic Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

et al. 2022

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BackgroundThe rate of patients with pancreatic ductal adenocarcinoma (PDAC) receiving neoadjuvant chemotherapy is increasing, but upfront resection is still offered to most patients with resectable or borderline resectable disease. Encouraging data reported in adjuvant chemotherapy trials prompts surgeons towards upfront surgery, but such trials are subject to a significant selection bias. This systematic review aims to summarize available high-quality evidence regarding survival of patients treated with upfront surgery for PDAC.MethodsPubmed, Cochrane, and Web of Science Databases were interrogated for prospective studies published between 2000 and 2021 that included at least a cohort of patients treated with upfront surgery for resectable or borderline resectable PDAC. The Cochrane Collaboration’s risk-of-bias tool for randomized trials (RoB-2) was used to assess risk of bias in all randomized studies. Patient weighted median overall survival (OS) and disease-free survival (DFS) were calculated.ResultsOverall, 8,341 abstracts were screened, 17 reports were reviewed in full text, and finally 5 articles and 1 conference abstract underwent data extraction. Included studies were published between 2014 and 2021. All studies were RCTs comparing different neoadjuvant treatment strategies to upfront surgery. Three studies included only resectable PDAC patients, two studies recruited patients with resectable and borderline resectable disease, and one study selected only borderline resectable patients. A total of 439 patients were included in the upfront resection cohorts of the 6 studies, ranging between 20 to 180 patients per study. The weighted median OS after upfront surgery was 18.8 (95% CI 12.4 – 20.6) months. Median DFS was 9 (95% CI 1.6 – 12.5) months. Resection rate was 74.5% (range 65-90%). Adjuvant treatment was initiated in 68% (range 43-77%) of resected patients.ConclusionsHigh-quality data for PDAC patients undergoing upfront surgery is scarce. Meta-analysis from the included studies showed a significantly shorter OS and DFS compared to recently published studies focusing on adjuvant combination chemotherapy, suggesting that the latter may overestimate survival due to the exclusion of most patients scheduled for upfront surgery.

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Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy

Marcinak

Parker

Parikh

et al. 2023

Journal of Surgical Oncology

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Background Outcomes for pancreatic adenocarcinoma (PDAC) remain difficult to prognosticate. Multiple models attempt to predict survival following the resection of PDAC, but their utility in the neoadjuvant population is unknown. We aimed to assess their accuracy among patients that received neoadjuvant chemotherapy (NAC). Methods We performed a multi‐institutional retrospective analysis of patients who received NAC and underwent resection of PDAC. Two prognostic systems were evaluated: the Memorial Sloan Kettering Cancer Center Pancreatic Adenocarcinoma Nomogram (MSKCCPAN) and the American Joint Committee on Cancer (AJCC) staging system. Discrimination between predicted and actual disease‐specific survival was assessed using the Uno C‐statistic and Kaplan–Meier method. Calibration of the MSKCCPAN was assessed using the Brier score. Results A total of 448 patients were included. There were 232 (51.8%) females, and the mean age was 64.1 years (±9.5). Most had AJCC Stage I or II disease (77.7%). For the MSKCCPAN, the Uno C‐statistic at 12‐, 24‐, and 36‐month time points was 0.62, 0.63, and 0.62, respectively. The AJCC system demonstrated similarly mediocre discrimination. The Brier score for the MSKCCPAN was 0.15 at 12 months, 0.26 at 24 months, and 0.30 at 36 months, demonstrating modest calibration. Conclusions Current survival prediction models and staging systems for patients with PDAC undergoing resection after NAC have limited accuracy.

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Transatlantic registries of pancreatic surgery in the United States of America, Germany, the Netherlands, and Sweden: Comparing design, variables, patients, treatment strategies, and outcomes

Cited by 44 publications

References 24 publications

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

The use and clinical outcome of total pancreatectomy in the United States, Germany, the Netherlands, and Sweden

Prognosis of Upfront Surgery for Pancreatic Cancer: A Systematic Review and Meta-Analysis of Prospective Studies

Accuracy of models to prognosticate survival after surgery for pancreatic cancer in the era of neoadjuvant therapy

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