M. Bakens

Hospital of diagnosis and likelihood of surgical treatment for pancreatic cancer

Surgical resection for pancreatic cancer offers the only chance of cure. Assessment of the resectability of a pancreatic tumour is therefore of great importance. The aim of the study was to investigate whether centre of diagnosis influences the likelihood of surgery and whether this affects long‐term survival.

The use of adjuvant chemotherapy for pancreatic cancer varies widely between hospitals: a nationwide population-based analysis

Adjuvant chemotherapy after pancreatoduodenectomy for pancreatic cancer is currently considered standard of care. In this nationwide study, we investigated which characteristics determine the likelihood of receiving adjuvant chemotherapy and its effect on overall survival. The data were obtained from the Netherlands Cancer Registry. All patients alive 90 days after pancreatoduodenectomy for M0‐pancreatic cancer between 2008 and 2013 in the Netherlands were included in this study. The likelihood to receive adjuvant chemotherapy was analyzed by multilevel logistic regression analysis and differences in time‐to‐first‐chemotherapy were tested for significance by Mann–Whitney U test. Overall survival was assessed by Kaplan–Meier method and Cox regression analysis. Of the 1195 patients undergoing a pancreatoduodenectomy for pancreatic cancer, 642 (54%) patients received adjuvant chemotherapy. Proportions differed significantly between the 19 pancreatic centers, ranging from 26% to 74% (P < 0.001). Median time‐to‐first‐chemotherapy was 6.7 weeks and did not differ between centers. Patients with a higher tumor stage, younger age, and diagnosed more recently were more likely to receive adjuvant treatment. The 5‐year overall survival was significantly prolonged in patients treated with adjuvant chemotherapy—23% versus 17%, log‐rank = 0.01. In Cox regression analysis, treatment with adjuvant chemotherapy significantly prolonged survival compared with treatment without adjuvant chemotherapy. The finding that elderly patients and patients with a low tumor stage are less likely to undergo treatment needs further attention, especially since adjuvant treatment is known to prolong survival in most of these patients.

Evaluation of Preoperative Biliary Drainage in Patients Undergoing Pancreatoduodenectomy For Suspected Pancreatic or Periampullary Cancer

Introduction A Dutch randomized trial showed that patients with obstructive jaundice due to periampullary tumors and a bilirubin below 250 μmol/l have a higher rate of complications after preoperative biliary drainage as compared to early surgery. Therefore, in the Netherlands the recommended treatment is early surgery without preoperative biliary drainage. This study investigated adherence to this recommendation. Methods A retrospective multicenter cohort study was performed in patients undergoing pancreatoduodenectomy for suspected malignancy in a 2-years period in seven Dutch high-volume centers. The proportion of and reasons for preoperative biliary drainage were studied. Results Pancreatoduodenectomy was performed in 609 patients, of whom 401 (66%) presented with preoperative jaundice. Of these, 245 patients had bilirubin levels below 250 μmol/l. Preoperative biliary drainage was performed in 165 (67%) of these patients. In the majority of patients, no medical reason justifying a preoperative biliary drainage could be retrieved from the medical charts (n=102, 62%). Preoperative biliary drainage was mostly performed in the hospital of diagnosis prior to referral to a pancreatic center (53%). After referral, the rate of preoperative biliary drainage varied considerably between pancreatic centers (13% - 58%, p<0.001). Conclusion In the Netherlands, more than half of the patients with obstructive jaundice still undergo preoperative biliary drainage prior to surgery in the Netherlands without an urgent medical reason. Given the negative influence of preoperative biliary drainage on outcome, this practice should be improved.