scholarly journals Achieving ‘Marginal Gains’ to Optimise Outcomes in Resectable Pancreatic Cancer

Cancers ◽  
2021 ◽  
Vol 13 (7) ◽  
pp. 1669
Author(s):  
Sarah Powell-Brett ◽  
Rupaly Pande ◽  
Keith J. Roberts
Keyword(s):  
Pancreatic Cancer ◽  
Enhanced Recovery ◽  
Perioperative Complications ◽  
Evidence Base ◽  
Modern Medicine ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer ◽  
Exocrine Insufficiency ◽  
Pancreatic Exocrine ◽  
Considerable Benefit

Improving outcomes among patients with resectable pancreatic cancer is one of the greatest challenges of modern medicine. Major improvements in survival will result from the development of novel therapies. However, optimising existing pathways, so that patients realise benefits of already proven treatments, presents a clear opportunity to improve outcomes in the short term. This narrative review will focus on treatments and interventions where there is a clear evidence base to improve outcomes in pancreatic cancer, and where there is also evidence of variation and under-treatment. Avoidance of preoperative biliary drainage, treatment of pancreatic exocrine insufficiency, prehabiliation and enhanced recovery after surgery, reducing perioperative complications, optimising opportunities for elderly patients to receive therapy, optimising adjuvant chemotherapy and regular surveillance after surgery are some of the strategies discussed. Each treatment or pathway change represents an opportunity for marginal gain. Accumulation of marginal gains can result in considerable benefit to patients. Given that these interventions already have evidence base, they can be realised quickly and economically.

scholarly journals Pancreatic Exocrine Insufficiency in Pancreatic Cancer

Nutrients ◽  
2017 ◽  
Vol 9 (3) ◽  
pp. 183 ◽  
Author(s):  
Miroslav Vujasinovic ◽  
Roberto Valente ◽  
Marco Del Chiaro ◽  
Johan Permert ◽  
J.-Matthias Löhr
Keyword(s):  
Pancreatic Cancer ◽  
Pancreatic Exocrine Insufficiency ◽  
Exocrine Insufficiency ◽  
Pancreatic Exocrine

Metal or plastic stents for preoperative biliary drainage in resectable pancreatic cancer

Gut ◽  
2015 ◽  
Vol 65 (12) ◽  
pp. 1981-1987 ◽  
Author(s):  
J A M G Tol ◽  
J E van Hooft ◽  
R Timmer ◽  
F J G M Kubben ◽  
E van der Harst ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Biliary Drainage ◽  
Preoperative Biliary Drainage ◽  
Plastic Stents ◽  
Resectable Pancreatic Cancer

Overall survival with preoperative biliary drainage in patients with resectable pancreatic cancer.

2014 ◽  
Vol 32 (3_suppl) ◽  
pp. 314-314
Author(s):  
Tobin Joel Crill Strom ◽  
Sarah E. Hoffe ◽  
Shivakumar Vignesh ◽  
Jason Klapman ◽  
Cynthia L. Harris ◽  
...  
Keyword(s):  
Pancreatic Cancer ◽  
Overall Survival ◽  
Cancer Patients ◽  
Tumor Size ◽  
Biliary Drainage ◽  
Cox Regression ◽  
Neoadjuvant Treatment ◽  
Preoperative Biliary Drainage ◽  
Resectable Pancreatic Cancer ◽  
Pathologic Features

314 Background: Resectable pancreatic cancer patients often present with obstructive jaundice necessitating the placement of biliary stents or percutaneouse drainage catheters. We sought to evaluate whether preoperative biliary drainage affects recurrence and survival. Methods: An IRB-approved study was conducted on our institutional tumor registry to identify pancreatic cancer patients who were treated with upfront surgery between 2000 and 2012. Patients were then stratified by preoperative use of endoscopically placed stents (ERCP), percutaneous catheters (PTC), or no biliary drainage (NBD). The primary endpoint was overall survival (OS). Survival curves were calculated using the Kaplan-Meier method and the log-rank test. Multivariate analysis (MVA) was performed with a Cox regression model. Results: We identified 202 patients for the study (21 PTC; 89 ERCP; 92 NBD). Key differences between the 3 groups were mean pathologic tumor size (p=0.005), pathologic T3/4 (p =0.01), and pathologic N1 (p=0.007) status, with more aggressive pathologic features in PTC patients. PTC patients had a non-significant increase in rate of hepatic recurrences compared with ERCP and NBD patients (47.4% vs. 26.6% vs. 28.7%, respectively; p=0.20). PTC patients also had worse median and 3 year survival (21 months and 16%) compared to ERCP (23.3 months and 39%) and NBD patients (29 months and 45%, p=0.02). MVA revealed that PTC was an independent predictor of worse overall survival (HR 2.3[95% CI 1.3-4.0], p=0.005), along with pathologic tumor size (HR 1.1[1.0-1.3], p=0.008), nodes positive (HR 1.1[1.1-1.2], p=0.001), and post-operative CA19-9 >90 (HR 2.6[1.5-4.4], p=0.001). Conclusions: Patients with resectable pancreatic cancer who require a pre-operative PTC drain had a non-significant increase in hepatic recurrence rate and worse overall survival than patients who either had an ERCP stent placed or no biliary decompression prior to surgery. Given their worse prognosis, patients who require PTC placement might also benefit from neoadjuvant treatment with restaging prior to surgery.

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