Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines.

Philip Mirgorod,Sameer A. Dhayat,Norbert Senninger,Christina Lenschow,Christoph Anthoni,Thorsten Vowinkel

doi:10.1371/journal.pone.0173374

Philip Mirgorod, Sameer A. Dhayat + Show 4 more

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https://doi.org/10.1371/journal.pone.0173374

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Journal: PloS one	Publication Date: Mar 7, 2017
Citations: 9	License type: CC BY 4.0

Affiliation: University Hospital Münster

Abstract

BackgroundPancreatic ductal adenocarcinoma (PDAC) remains one of the most deadly cancers in Europe and the USA. There is consensus that radical tumor surgery is the only viable option for any long-term survival in patients with PDAC. So far, limited data are available regarding the routine surgical management of patients with advanced PDAC in the light of surgical guidelines.MethodsA national survey on perioperative management of patients with PDAC and currently applied criteria on their tumor resectability in German university and community hospitals was carried out.ResultsWith a response rate of 81.6% (231/283) a total of 95 (41.1%) participating departments practicing pancreatic surgery in Germany are certified as competence and reference centers for surgical diseases of the pancreas in 2016. More than 95% of them indicate to carry out structured and interdisciplinary therapies along with an interdisciplinary pre- and postoperative tumor board. The majority of survey respondents prefer the pylorus-preserving partial pancreatoduodenectomy (93.1%) with standard lymphadenectomy for cancer of the pancreatic head. Intraoperative histological evaluation of the resection margins is used regularly by 99% of the survey respondents. 98.7% of survey respondents carry out partial or complete vein resection, 126 respondents (54.5%) would resect tumor adjacent arteries, and 102 respondents (44.2%) would perform metastasectomy if complete PDAC resection (R0) is possible.ConclusionEvidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany. However, a significant number of survey respondents support an extended radical tumor resection in patients with advanced PDAC even when not indicated by current clinical guidelines.

Highlights

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer related death in western countries, and it is expected to rise to second place behind lung cancer until 2030.[1]
Evidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany
In contrast to stable or declining trends for most cancers in Europe since 2009, PDAC shows an increase of 3.6% and 5.2% for men and women, respectively, with predicted death rates of 8.2 and 5.6/100 000 corresponding to 85 300 total deaths in 2015

Summary

Introduction

Pancreatic ductal adenocarcinoma (PDAC) is currently the fourth leading cause of cancer related death in western countries, and it is expected to rise to second place behind lung cancer until 2030.[1] In contrast to stable or declining trends for most cancers in Europe since 2009, PDAC shows an increase of 3.6% and 5.2% for men and women, respectively, with predicted death rates of 8.2 and 5.6/100 000 corresponding to 85 300 total deaths in 2015. Oncological surgery with tumor extirpation as the only curative treatment option of PDAC at early stages, so far, is possible in only 15% of PDAC patients with 5-year survival rates below 20%.[4] To date, national and international guidelines for the treatment of PDAC patients differentiate between resectable, borderline resectable, locally advanced unresectable, and metastatic PDAC.[5,6,7] there is a wide range of definitions available for borderline PDAC resectability.

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