Proclivity to Explore Locally Advanced Pancreas Cancer Is Not Associated with Surgeon Volume

Published on May 23, 2021in Journal of Gastrointestinal Surgery2.573
· DOI :10.1007/S11605-021-05034-W
Alex B. Blair17
Estimated H-index: 17
(Johns Hopkins University),
Robert W. Krell17
Estimated H-index: 17
+ 9 AuthorsBradley N. Reames3
Estimated H-index: 3
(UNMC: University of Nebraska Medical Center)
Sources
Abstract
BACKGROUND AND PURPOSE There is limited high-level evidence to guide locally advanced pancreas cancer (LAPC) management. Recent work shows that surgeons' preferences in LAPC management vary broadly. We sought to examine whether surgeon volume was associated with attitudes regarding LAPC management. METHODS An electronic survey was distributed by email to an international cohort of pancreas surgeons to evaluate practice patterns regarding LAPC management. Clinical vignette-based questions evaluated surgeons' attitudes regarding patient eligibility and the proclivity to offer exploration. Surgeons were classified into "low-" or "high-volume" categories according to thresholds of self-reported annual pancreatectomy volume. Surgeon's attitudes regarding LAPC management and inclination to consider exploration were compared across annual volume categories. RESULTS A total of 153 eligible responses were received from 4 continents, for an estimated response rate of 10.6%. Median duration of practice was 12 years (IQR 6-20). Most respondents reported >25 cases/year (89, 58.2%), of which 34 (22.2%) reported >50. Compared to surgeons with 25 cases/year practiced longer (median 15 vs. 7.5 years, P 50 cases/year were more likely to offer arterial resection (70.6% vs. 43.7%, P=0.006). The willingness to offer (or defer) exploration did not differ across any categories of surgeons' annual case volume. CONCLUSIONS In an international survey of pancreas surgeons, the proclivity to consider exploration for LAPC was not associated with multiple categories of surgeon volume. Better evidence is needed to define the optimal management approach to LAPC.
References38
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#1Bradley N. Reames (UNMC: University of Nebraska Medical Center)H-Index: 19
#1Bradley N. Reames (UNMC: University of Nebraska Medical Center)H-Index: 2
Last. Jin He (Johns Hopkins University)H-Index: 40
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MiniAn international survey of high-volume pancreas cancer surgeons revealed wide variations in management preferences, attitudes regarding contraindications to surgery, and the propensity to offer exploration. When presented with 6 hypothetical clinical vignettes using details from real patients th
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#1Mark J. TrutyH-Index: 31
#2Michael L. KendrickH-Index: 58
Last. Axel GrotheyH-Index: 86
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MiniTotal neoadjuvant therapy, or systemic induction chemotherapy followed by chemoradiation, is an optimal preoperative sequencing strategy for patients with borderline resectable or locally advanced pancreatic adenocarcinoma. This strategy allows high rate of negative margins despite low frequency
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#1Matthias Ilmer (DKFZ: German Cancer Research Center)H-Index: 18
#2Tobias S. Schiergens (LMU: Ludwig Maximilian University of Munich)H-Index: 17
Last. Jan G. D'Haese (LMU: Ludwig Maximilian University of Munich)H-Index: 16
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Abstract Objective To assess the perioperative and long-term outcome following pulmonary resection in patients with metachronous metastasis of pancreatic ductal adenocarcinoma (PDAC). Background Most patients with PDAC relapse or develop tumor spread to secondary organs. Currently, it remains unclear how to proceed with pulmonary metastasis in the metachronous setting. In particular, the role of surgery remains controversial. Methods Data of patients with pulmonary metachronous metastasis after ...
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#1Alex B. Blair (Johns Hopkins University)H-Index: 17
#2Ling-Di Yin (Johns Hopkins University)
Last. Jin He (Johns Hopkins University)H-Index: 40
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OBJECTIVE: The aim of this study was to characterize the patterns and treatment of disease recurrence in patients achieving a pathological complete response (pCR) following neoadjuvant chemoradiation for advanced pancreatic ductal adenocarcinoma (PDAC). SUMMARY OF BACKGROUND DATA: A pCR is an independent predictor for improved survival in PDAC. However, disease recurrence is still observed in these patients. METHODS: Patients with advanced PDAC who were treated with neoadjuvant therapy and had a...
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#1Vincent P. Groot (UU: Utrecht University)H-Index: 16
#2Alex B. Blair (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
Last. Jin He (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 40
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Abstract Background The literature suggests favorable survival for patients with isolated pulmonary recurrence after resection of pancreatic ductal adenocarcinoma (PDAC) as compared to other recurrence patterns. Within this cohort, it remains unclear what factors are associated with improved survival. Methods Patients who developed pulmonary recurrence after pancreatectomy were selected from a prospective database. Predictors for post-recurrence survival (PRS) were analyzed using a multivariable...
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#1Georgios Gemenetzis (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
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Last. Jin He (Johns Hopkins University)H-Index: 40
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Objective:The aim of the study was to identify the survival of patients with locally advanced pancreatic cancer (LAPC) and assess the effect of surgical resection after neoadjuvant therapy on patient outcomes.Background:An increasing number of LAPC patients who respond favorably to neoadjuvant thera
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Last. Marc G. BesselinkH-Index: 84
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Locally advanced pancreatic cancer (LAPC) has several definitions but essentially is a nonmetastasized pancreatic cancer, in which upfront resection is considered not beneficial due to extensive vascular involvement and consequent high chance of a nonradical resection. The introduction of FOLFIRINOX chemotherapy and gemcitabine-nab-paclitaxel (gem-nab) has had major implications for the management and outcome of patients with LAPC. After 4–6 months induction chemotherapy, the majority of patient...
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#1Stefan HeinrichH-Index: 33
#2Marc G. Besselink (UvA: University of Amsterdam)H-Index: 84
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Background Several new treatment options have become available for pancreatic ductal adenocarcinoma (PDAC), but the support for their use for resectable, borderline resectable and locally advanced PDAC is unclear.
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#1Jakob Kirkegård (Aarhus University Hospital)H-Index: 10
#2Eirik Kjus AahlinH-Index: 6
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Background: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed. Methods: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical...
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#1Jin He (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 40
#2Alex B. Blair (JHUSOM: Johns Hopkins University School of Medicine)H-Index: 17
Last. Christopher L. Wolfgang (Johns Hopkins University)H-Index: 102
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Objectives:To describe the survival outcome of patients with borderline resectable or locally advanced pancreatic ductal adenocarcinoma (BR/LA-PDAC) who have a pathologic complete response (pCR) following neoadjuvant chemoradiation.Background:Patients with BR/LA-PDAC are often treated with neoadjuva
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