Abstract
Simple SummaryImproving outcomes in pancreatic cancer is achievable through the accumulation of marginal gains. There exists evidence of variation and undertreatment in many areas of the care pathway. By fully realising the existing opportunities, there is the potential for immediate improvements in outcomes and quality of life.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.
Highlights
Pancreatic cancer is projected to become the second leading cause of all cancer-related deaths by 2030 [1,2]
This review sought to elucidate key areas of variation, undertreatment and pathway changes where improvements can be realised with little effort
Novel therapeutic options will present themselves in the future, but it would be remiss of any team caring for this cohort of patients to inadequately utilise current evidence and implement optimal treatment pathways
Summary
Pancreatic cancer is projected to become the second leading cause of all cancer-related deaths by 2030 [1,2]. The principals have been adopted in healthcare among various patient populations from cancer surgery, stroke recovery, prehabilitation, cardiac surgery and anaesthesia [4,5,6]. This narrative review highlights common failings in the care of pancreatic cancer patients and describes where gains can be made. The aggregation of these marginal gains could improve outcomes and experience for a great many patients with resectable pancreatic cancer
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