Scott Hurton

The current state of pancreatic cancer in Canada: incidence, mortality, and surgical therapy.

Objective This study aimed to evaluate the trends in the incidence, survival, and surgical therapy for Canadian patients affected by pancreatic cancer (PC). Methods The incidence, mortality, number of resections, and outcomes of patients with PC stratified by year, sex, and province were extracted from Canadian cancer databases. Results In 2012, PC was diagnosed in 4600 Canadians and it was responsible for 4300 deaths. The age-standardized incidence was 9 to 10 new cases per 100,000 individuals. The mortality rate remained the highest among all the solid tumors with a case-to-fatality ratio of 0.93. The age-standardized 5-year relative survival was 9.1% (95% confidence interval [CI], 8.3–10). There were geographic variations among provinces with the highest survival registered in Ontario (10.9%; 95% CI, 9.9–12) and the lowest survival reported in Nova Scotia (4.7%; 95% CI, 2.8–7.2). The percentage of patients who underwent surgery decreased from 19% (2006–2007) to 17% (2009–2010). Pancreatic resections were performed in high-volume centers in 74% of cases. In-hospital mortality was 5%, 93% of patients were discharged home, and 36% of patients required home support after discharge. Conclusions Long-term outcomes of Canadian patients affected by PC remain unsatisfactory, with only 9% of the patients surviving at 5 years. Surgical therapy was performed only in 17% to 19% of patients.

Obesity and liver transplantation

The percentage of overweight and obese patients (OPs) waiting for a liver transplant continues to increase. Despite the significant advances occurred in bariatric medicine, obesity is still considered a relative contraindication to liver transplantation (LT). The main aim of this review is to appraise the literature on the outcomes of OPs undergoing LT, treatments that might reduce their weight before, during or after surgery, and discuss some of the controversies and limitations of the current knowledge with the intent of highlighting areas where future research is needed.

Risks and Benefits of Early Catheter Removal After Renal Transplantation.

Although many advances in renal transplantation have occurred over recent decades, bladder catheterization has remained a constant practice to facilitate the identification of the dome of the bladder by retrograde infusion of antibiotic solutions in its lumen prior to the creation of the cystoureteric anastomosis. In addition, the presence of the Foley catheter prevents possible tension on the newly created anastomosis between the ureter and the bladder as it allows continuous external drainage of urine and is very useful to monitor perioperative fluid balance. Although urethral catheterization provides several benefits, the optimal duration of catheterization remains a subject of controversy. The primary aim of this paper is to review the available scientific literature on the management of urethral catheters after renal transplantation and assess the pros and cons of early vs late catheter removal.

Advances in Pancreatic Cancer: The Role of Metabolomics

Metabolomics is an emerging scientific field focusing on compounds, also known as metabolomes that are produced by biologic systems. Metabolomes represent phenotypic end-products of living entities, and are of particular interest as they represent a novel group of biomarkers that can be used for diagnosis, monitoring response to treatments, and more recently as potential therapeutic agents for benign but more so for malignant diseases. One of the main factors associated with improved survival of patients affected by malignancies is early diagnosis, particularly for those tumors with poor prognosis such as pancreatic cancer. Currently, there are no diagnostic tests for the screening of pancreatic cancer, and although novel biomarkers continue to be discovered, none has yet to be proven useful for this purpose. The main aims of this paper are to review the current literature and to summarize the most relevant advances in the field of metabolomics applied to pancreatic adenocarcinoma. Image: Dalhousie University. Halifax, Nova Scotia, Canada.

Levels in Decision Making and Techniques for Clinicians

In the last century, there has been tremendous advancements in medicine and surgery and this progress has resulted in an over expansion of the number of treatment options that are available to treat many conditions. The enlarging armamentarium available to modern physicians should be celebrated. However, this has come with a significant increase in the complexity of decisions that physicians have to make when they select a therapy among many that have comparable efficacy. For example, small hepatocellular carcinomas can be treated with liver transplantation, surgical resection or locoregional therapies, with similar overall survival but different disease free survival and morbidities. One of the primary goals of decision analysis is to help decision makers. In healthcare, this translates in more cost-effective treatments, higher patients’ satisfaction and overall better outcomes. Because judgments of uncertainty are a critical part of medical decision-making, decision analysis tends to improve the accuracy of these judgments by using specific algorithms and techniques. The main aim of this review is to make clinicians familiar with the different levels of decision analysis. In this paper, we will describe common techniques that are used to elicit patients’ preferences, the meaning of utilities and the benefit and limitations of decision analysis in health care.

Are Quality Indicators associated with Postoperative Outcomes after Resection for Pancreatic Adenocarcinoma

Introduction: Although quality of care has become a central aspect of modern medicine, a definite relationship between quality indicators (QIs) and outcomes has not been fully established in patients with pancreatic cancer (PC). The primary aim of this study was to examine the possible association of established process-based QIs with short and long term outcomes in patients undergoing PC resection. Methods: All adult patients undergoing resection for PC in Nova Scotia between 2001 and 2011 were included in a retrospective cohort study. Logistic and Cox model regression analyses were used to test the hypothesis that meeting selected QIs was associated with improved perioperative morbidity, mortality and overall survival. Results: Pancreaticoduoedenectomy was performed in 82 (87%) patients and distal pancreatectomy in 12 patients (13%). Multivariable analysis adjusting for patient and tumour characteristics showed that only preoperative radiological staging obtained within 8 weeks from the date of surgery was associated with better survival (HR for death=0.34, 95% CI=0.14-0.84). Other QIs failed to show any association with perioperative morbidity and mortality and overall survival. Conclusions: With the exception of preoperative staging within the recommended time interval, meeting QIs was not associated with improved short and long term outcome in resected PC patients.