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1

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Outcome of Pancreatic Surgery During the First 6 Years of a Mandatory Audit Within the Dutch Pancreatic Cancer Group

Suurmeijer, J. Annelie ; Henry, Anne Claire ; Bonsing, Bert A. ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Annals of Surgery Vol. 278, No. 2 ( 2023-08), p. 260-266

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In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 278, No. 2 ( 2023-08), p. 260-266

Abstract: To describe outcome after pancreatic surgery in the first 6 years of a mandatory nationwide audit. Background: Within the Dutch Pancreatic Cancer Group, efforts have been made to improve outcome after pancreatic surgery. These include collaborative projects, clinical auditing, and implementation of an algorithm for early recognition and management of postoperative complications. However, nationwide changes in outcome over time have not yet been described. Methods: This nationwide cohort study included consecutive patients after pancreatoduodenectomy (PD) and distal pancreatectomy from the mandatory Dutch Pancreatic Cancer Audit (January 2014–December 2019). Patient, tumor, and treatment characteristics were compared between 3 time periods (2014–2015, 2016–2017, and 2018–2019). Short-term surgical outcome was investigated using multilevel multivariable logistic regression analyses. Primary endpoints were failure to rescue (FTR) and in-hospital mortality. Results: Overall, 5345 patients were included, of whom 4227 after PD and 1118 after distal pancreatectomy. After PD, FTR improved from 13% to 7.4% [odds ratio (OR) 0.64, 95% confidence interval (CI) 0.50–0.80, P 〈 0.001] and in-hospital mortality decreased from 4.1% to 2.4% (OR 0.68, 95% CI 0.54–0.86, P =0.001), despite operating on more patients with age 〉 75 years (18%–22%, P =0.006), American Society of Anesthesiologists score ≥3 (19%–31%, P 〈 0.001) and Charlson comorbidity score ≥2 (24%–34%, P 〈 0.001). The rates of textbook outcome (57%–55%, P =0.283) and major complications remained stable (31%–33%, P =0.207), whereas complication-related intensive care admission decreased (13%–9%, P =0.002). After distal pancreatectomy, improvements in FTR from 8.8% to 5.9% (OR 0.65, 95% CI 0.30–1.37, P =0.253) and in-hospital mortality from 1.6% to 1.3% (OR 0.88, 95% CI 0.45–1.72, P =0.711) were not statistically significant. Conclusions: During the first 6 years of a nationwide audit, in-hospital mortality and FTR after PD improved despite operating on more high-risk patients. Several collaborative efforts may have contributed to these improvements.

Type of Medium: Online Resource

ISSN: 0003-4932

URL: Article

DOI: 10.1097/SLA.0000000000005628

RVK:

XA 23900

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 2002200-1

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2

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Detection, Treatment, and Survival of Pancreatic Cancer Recurrence in the Netherlands : A Nationwide Analysis

Daamen, Lois A. ; Groot, Vincent P. ; Besselink, Marc G. ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2022

In: Annals of Surgery Vol. 275, No. 4 ( 2022-04), p. 769-775

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In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. 275, No. 4 ( 2022-04), p. 769-775

Abstract: To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival. Summary of Background data: International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence. Methods: A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014–2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence. Results: Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5–17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients ( P 〈 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42–0.67); P 〈 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29–0.70); P 〈 0.001]. Conclusions: Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.

Type of Medium: Online Resource

ISSN: 0003-4932 , 1528-1140

URL: Article

DOI: 10.1097/SLA.0000000000004093

RVK:

XA 23900

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2022

detail.hit.zdb_id: 2641023-0

detail.hit.zdb_id: 2002200-1

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3

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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 ; for the Dutch Pancreatic Cancer Group ; Henry, Anne Claire ; [et al.]

Springer Science and Business Media LLC ; 2020

In: Trials Vol. 21, No. 1 ( 2020-12)

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In: Trials, Springer Science and Business Media LLC, Vol. 21, No. 1 ( 2020-12)

Abstract: Pancreatic resection is a major abdominal operation with 50% risk of postoperative complications. A common complication is pancreatic fistula, which may have severe clinical consequences such as postoperative bleeding, organ failure and death. The objective of this study is to investigate whether implementation of an algorithm for early detection and minimally invasive management of pancreatic fistula may improve outcomes after pancreatic resection. Methods This is a nationwide stepped-wedge, cluster-randomized, superiority trial, designed in adherence to the Consolidated Standards of Reporting Trials (CONSORT) guidelines. During a period of 22 months, all Dutch centers performing pancreatic surgery will cross over in a randomized order from current practice to best practice according to the algorithm. This evidence-based and consensus-based algorithm will provide daily multilevel advice on the management of patients after pancreatic resection (i.e. indication for abdominal imaging, antibiotic treatment, percutaneous drainage and removal of abdominal drains). The algorithm is designed to aid early detection and minimally invasive step-up management of postoperative pancreatic fistula. Outcomes of current practice will be compared with outcomes after implementation of the algorithm. The primary outcome is a composite of major complications (i.e. post-pancreatectomy bleeding, new-onset organ failure and death) and will be measured in a sample size of at least 1600 patients undergoing pancreatic resection. Secondary endpoints include the individual components of the primary endpoint and other clinical outcomes, healthcare resource utilization and costs analysis. Follow up will be up to 90 days after pancreatic resection. Discussion It is hypothesized that a structured nationwide implementation of a dedicated algorithm for early detection and minimally invasive step-up management of postoperative pancreatic fistula will reduce the risk of major complications and death after pancreatic resection, as compared to current practice. Trial registration Netherlands Trial Register: NL 6671 . Registered on 16 December 2017.

Type of Medium: Online Resource

ISSN: 1745-6215

URL: Article

DOI: 10.1186/s13063-020-4167-9

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2020

detail.hit.zdb_id: 2040523-6

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4

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Nationwide use and outcome of Minimally Invasive Distal Pancreatectomy in IDEAL Stage IV following a Training Program and Randomized Trial

Korrel, Maarten ; van Hilst, Jony ; Bosscha, Koop ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Annals of Surgery Vol. Publish Ahead of Print ( 2023-05-4)

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In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. Publish Ahead of Print ( 2023-05-4)

Type of Medium: Online Resource

ISSN: 0003-4932

URL: Article

DOI: 10.1097/SLA.0000000000005900

RVK:

XA 23900

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 2002200-1

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5

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Minimum and Optimal CA19-9 Response After Two Months Induction Chemotherapy in Patients with Locally Advanced Pancreatic Cancer : A Nationwide Multicenter Study

Seelen, Leonard W.F. ; Doppenberg, Deesje ; Stoop, Thomas F. ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Annals of Surgery

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In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health)

Abstract: This nationwide multicenter study aimed to define clinically relevant thresholds of relative serum CA19-9 response after 2 months induction chemotherapy in patients with locally advanced pancreatic cancer (LAPC). Summary Background Data: CA19-9 is seen as leading biomarker for response evaluation in patients with LAPC, but early clinically useful cut-offs are lacking. Methods: All consecutive patients with LAPC after 4 cycles (m)FOLFIRINOX or 2 cycles gemcitabine-nab-paclitaxel induction chemotherapy (±radiotherapy) with CA19-9 ≥5 U/mL at baseline were analyzed (2015–2019). The association of CA19-9 response with median OS (mOS) was evaluated for different CA19-9 cut-off points. Minimum and optimal CA19-9 response were established via log-rank test. Predictors for OS were analyzed, using cox regression analysis. Results: Overall, 212 patients were included of whom 42 (19.8%) underwent resection. Minimum CA19-9 response demonstrating a clinically significant mOS difference (12.7 vs. 19.6 mo) was seen at ≥40% CA19-9 decrease. The optimal cut-off for CA19-9 response was ≥60% decrease (21.7 vs. 14.0 mo, P =0.021). Only for patients with elevated CA19-9 levels at baseline ( n =184), CA19-9 decrease ≥60% (HR=0.59, 95%CI 0.36–0.98, P =0.042) was independently associated with prolonged OS, as were SBRT (HR=0.42, 95%CI 0.25–0.70; P =0.001), and resection (HR=0.25, 95%CI 0.14–0.46, P 〈 0.001), and duration of chemotherapy (HR=0.75, 95%CI 0.69–0.82, P 〈 0.001). Conclusion: CA19-9 decrease of ≥60% following induction chemotherapy as optimal response cut-off in patients with LAPC is an independent predictor for OS when CA19-9 is increased at baseline. Furthermore, ≥40% is the minimum cut-off demonstrating survival benefit. These cut-offs may be used when discussing treatment strategies during early response evaluation.

Type of Medium: Online Resource

ISSN: 0003-4932

URL: Article

DOI: 10.1097/SLA.0000000000006021

RVK:

XA 23900

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 2002200-1

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6

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Short- and Long-Term Outcomes of Pancreatic Cancer Resection in Elderly Patients: A Nationwide Analysis

Henry, Anne Claire ; Schouten, Thijs J. ; Daamen, Lois A. ; [et al.]

Springer Science and Business Media LLC ; 2022

In: Annals of Surgical Oncology Vol. 29, No. 9 ( 2022-09), p. 6031-6042

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In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 29, No. 9 ( 2022-09), p. 6031-6042

Abstract: The number of elderly patients with pancreatic cancer is growing, however clinical data on the short-term outcomes, rate of adjuvant chemotherapy, and survival in these patients are limited and we therefore performed a nationwide analysis. Methods Data from the prospective Dutch Pancreatic Cancer Audit were analyzed, including all patients undergoing pancreatic cancer resection between January 2014 and December 2016. Patients were classified into two age groups: 〈 75 and ≥75 years. Major complications (Clavien–Dindo grade 3 or higher), 90-day mortality, rates of adjuvant chemotherapy, and survival were compared between age groups. Factors associated with start of adjuvant chemotherapy and survival were evaluated with logistic regression and multivariable Cox regression analysis. Results Of 836 patients, 198 were aged ≥75 years (24%) and 638 were aged 〈 75 years (76%). Median follow-up was 38 months (interquartile range [IQR] 31–47). Major complications (31% vs. 28%; p = 0.43) and 90-day mortality (8% vs. 5%; p = 0.18) did not differ. Adjuvant chemotherapy was started in 37% of patients aged ≥75 years versus 69% of patients aged 〈 75 years ( p 〈 0.001). Median overall survival (OS) was 15 months (95% confidence interval [CI] 14–18) versus 21 months (95% CI 19–24; p 〈 0.001). Age ≥75 years was not independently associated with OS (hazard ratio 0.96, 95% CI 0.79–1.17; p = 0.71), but was associated with a lower rate of adjuvant chemotherapy (odds ratio 0.27, 95% CI 0.18–0.40; p 〈 0.001). Conclusions The rate of major complications and 90-day mortality after pancreatic resection did not differ between elderly and younger patients; however, elderly patients were less often treated with adjuvant chemotherapy and their OS was shorter.

Type of Medium: Online Resource

ISSN: 1068-9265 , 1534-4681

URL: Article

DOI: 10.1245/s10434-022-11831-7

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2022

detail.hit.zdb_id: 2074021-9

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7

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

de Bakker, Jacob K. ; Suurmeijer, J. Annelie ; Toennaer, Jurgen G. J. ; [et al.]

Springer Science and Business Media LLC ; 2023

In: Annals of Surgical Oncology Vol. 30, No. 4 ( 2023-04), p. 2448-2455

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In: Annals of Surgical Oncology, Springer Science and Business Media LLC, Vol. 30, No. 4 ( 2023-04), p. 2448-2455

Abstract: 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.

Type of Medium: Online Resource

ISSN: 1068-9265 , 1534-4681

URL: Article

DOI: 10.1245/s10434-022-12701-y

Language: English

Publisher: Springer Science and Business Media LLC

Publication Date: 2023

detail.hit.zdb_id: 2074021-9

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8

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Treatment and survival of resected and unresected distal cholangiocarcinoma: a nationwide study

Strijker, Marin ; Belkouz, Ali ; van der Geest, Lydia G. ; [et al.]

Informa UK Limited ; 2019

In: Acta Oncologica Vol. 58, No. 7 ( 2019-07-03), p. 1048-1055

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In: Acta Oncologica, Informa UK Limited, Vol. 58, No. 7 ( 2019-07-03), p. 1048-1055

Type of Medium: Online Resource

ISSN: 0284-186X , 1651-226X

URL: Article

DOI: 10.1080/0284186X.2019.1590634

Language: English

Publisher: Informa UK Limited

Publication Date: 2019

detail.hit.zdb_id: 1492623-4

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9

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Risk Models for Developing Pancreatic Fistula after Pancreatoduodenectomy: Validation in a Nationwide Prospective Cohort

Schouten, Thijs J. ; Henry, Anne Claire ; Smits, F. Jasmijn ; [et al.]

Ovid Technologies (Wolters Kluwer Health) ; 2023

In: Annals of Surgery Vol. Publish Ahead of Print ( 2023-02-20)

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In: Annals of Surgery, Ovid Technologies (Wolters Kluwer Health), Vol. Publish Ahead of Print ( 2023-02-20)

Type of Medium: Online Resource

ISSN: 0003-4932

URL: Article

DOI: 10.1097/SLA.0000000000005824

RVK:

XA 23900

Language: English

Publisher: Ovid Technologies (Wolters Kluwer Health)

Publication Date: 2023

detail.hit.zdb_id: 2002200-1

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10

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Predicting overall survival and resection in patients with locally advanced pancreatic cancer treated with FOLFIRINOX: Development and internal validation of two nomograms

Brada, Lilly J. H. ; Walma, Marieke S. ; Daamen, Lois A. ; [et al.]

Wiley ; 2021

In: Journal of Surgical Oncology Vol. 124, No. 4 ( 2021-09), p. 589-597

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In: Journal of Surgical Oncology, Wiley, Vol. 124, No. 4 ( 2021-09), p. 589-597

Abstract: Patients with locally advanced pancreatic cancer (LAPC) are increasingly treated with FOLFIRINOX, resulting in improved survival and resection of tumors that were initially unresectable. It remains unclear, however, which specific patients benefit from FOLFIRINOX. Two nomograms were developed predicting overall survival (OS) and resection at the start of FOLFIRINOX for LAPC. Methods From our multicenter, prospective LAPC registry in 14 Dutch hospitals, LAPC patients starting first‐line FOLFIRINOX (April 2015–December 2017) were included. Stepwise backward selection according to the Akaike Information Criterion was used to identify independent baseline predictors for OS and resection. Two prognostic nomograms were generated. Results A total of 252 patients were included, with a median OS of 14 months. Thirty‐two patients (13%) underwent resection, with a median OS of 23 months. Older age, female sex, Charlson Comorbidity Index ≤1, and CA 19.9 〈 274 were independent factors predicting a better OS (c‐index: 0.61). WHO ps 〉 1, involvement of the superior mesenteric artery, celiac trunk, and superior mesenteric vein ≥ 270° were independent factors decreasing the probability of resection (c‐index: 0.79). Conclusions Two nomograms were developed to predict OS and resection in patients with LAPC before starting treatment with FOLFIRINOX. These nomograms could be beneficial in the shared decision‐making process and counseling of these patients.

Type of Medium: Online Resource

ISSN: 0022-4790 , 1096-9098

URL: Issue

URL: Article

DOI: 10.1002/jso.v124.4

DOI: 10.1002/jso.26567

Language: English

Publisher: Wiley

Publication Date: 2021

detail.hit.zdb_id: 1475314-5

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