Clinical decisions in pancreatic cancer surgery: a national survey and case-vignette study.

Autor: Ramia JM; Department of Surgery, Hospital General Universitario de Alicante, Sol Naciente 8, 16D, 03016, Alicante, Spain. jose_ramia@hotmail.com.; Institute for Health and Biomedical Research (ISABIAL), Alicante, Spain. jose_ramia@hotmail.com., Cugat E; Department of Surgery, Hospital Universitario Germans Trias i Puyol and Hospital Universitario Mútua Terrassa, Barcelona, Spain., De la Plaza R; Department of Surgery, Hospital Universitario de Guadalajara, Guadalajara, Spain., Gomez-Bravo MA; Department of Surgery, Hospital Universitario Virgen del Rocio, Seville, Spain., Martín E; Department of Surgery, Hospital Universitario La Princesa, Madrid, Spain., Muñoz-Bellvis L; Department of Surgery, University Hospital of Salamanca, Salamanca, Spain.; Institute of Biomedical Research of Salamanca (IBSAL), Universidad de Salamanca and Biomedical Research Networking Centre Consortium-CIBER-CIBERONC, Salamanca, Spain., Padillo FJ; Department of Surgery, Hospital Universitario Virgen del Rocio, Seville, Spain., Sabater L; Department of Surgery, Hospital Clínico, Biomedical Research Institute, University of Valencia, Valencia, Spain., Serradilla-Martín M; Department of Surgery, Instituto de Investigación Sanitaria Aragón, Hospital Universitario Miguel Servet, Zaragoza, Spain.
Jazyk: angličtina
Zdroj: Updates in surgery [Updates Surg] 2023 Jan; Vol. 75 (1), pp. 115-131. Date of Electronic Publication: 2022 Nov 14.
DOI: 10.1007/s13304-022-01415-1
Abstrakt: Very few surveys have been carried out of oncosurgical decisions made in patients with pancreatic cancer (PC), or of the possible differences in therapeutic approaches between low/medium and high-volume centers. A survey was sent out to centers affiliated to the Spanish Group of Pancreatic Surgery (GECP) asking about their usual pre-, intra- and post-operative management of PC patients and describing five imaginary cases of PC corresponding to common scenarios that surgeons regularly assess in oncosurgical meetings. A consensus was considered to have been reached when 80% of the answers coincided. We received 69 responses from the 72 GECP centers (response rate 96%). Pre-operative management: consensus was obtained on 7/16 questions (43.75%) with no significant differences between low- vs high-volume centers. Intra-operative: consensus was obtained on 11/28 questions (39.3%). D2 lymphadenectomy, biliary culture, intra-operative biliary margin study, pancreatojejunostomy, and two loops were significantly more frequent in high-volume hospitals (p < 0.05). Post-operative: consensus was obtained on 2/8 questions (25%). No significant differences were found between low-/medium- vs high-volume hospitals. Of the 41 questions asked regarding the cases, consensus was reached on 22 (53.7%). No differences in the responses were found according to the type of hospital. Management and cases: consensus was reached in 42/93 questions (45.2%). At GECP centers, consensus was obtained on 45% of the questions. Only 5% of the answers differed between low/medium and high-volume centers (all intra-operative). A more specific assessment of why high-volume centers obtain the best results would require the design of complex prospective studies able to measure the therapeutic decisions made and the effectiveness of their execution. Clinicaltrials.gov identifier: NCT04755036.
(© 2022. Italian Society of Surgery (SIC).)
Databáze: MEDLINE
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