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

BACKGROUND: Pancreatic 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 surgica...

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Autores principales: Dhayat, Sameer A., Mirgorod, Philip, Lenschow, Christina, Senninger, Norbert, Anthoni, Christoph, Vowinkel, Thorsten
Formato: Online Artículo Texto
Lenguaje:English
Publicado: Public Library of Science 2017
Materias:
Acceso en línea:https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340358/
https://www.ncbi.nlm.nih.gov/pubmed/28267771
http://dx.doi.org/10.1371/journal.pone.0173374
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author Dhayat, Sameer A.
Mirgorod, Philip
Lenschow, Christina
Senninger, Norbert
Anthoni, Christoph
Vowinkel, Thorsten
author_facet Dhayat, Sameer A.
Mirgorod, Philip
Lenschow, Christina
Senninger, Norbert
Anthoni, Christoph
Vowinkel, Thorsten
author_sort Dhayat, Sameer A.
collection PubMed
description BACKGROUND: Pancreatic 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. METHODS: A 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. RESULTS: With 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. CONCLUSION: Evidence-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.
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spelling pubmed-53403582017-03-10 Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines Dhayat, Sameer A. Mirgorod, Philip Lenschow, Christina Senninger, Norbert Anthoni, Christoph Vowinkel, Thorsten PLoS One Research Article BACKGROUND: Pancreatic 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. METHODS: A 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. RESULTS: With 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. CONCLUSION: Evidence-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. Public Library of Science 2017-03-07 /pmc/articles/PMC5340358/ /pubmed/28267771 http://dx.doi.org/10.1371/journal.pone.0173374 Text en © 2017 Dhayat et al http://creativecommons.org/licenses/by/4.0/ This is an open access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/4.0/) , which permits unrestricted use, distribution, and reproduction in any medium, provided the original author and source are credited.
spellingShingle Research Article
Dhayat, Sameer A.
Mirgorod, Philip
Lenschow, Christina
Senninger, Norbert
Anthoni, Christoph
Vowinkel, Thorsten
Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title_full Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title_fullStr Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title_full_unstemmed Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title_short Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines
title_sort challenges in pancreatic adenocarcinoma surgery - national survey and current practice guidelines
topic Research Article
url https://www.ncbi.nlm.nih.gov/pmc/articles/PMC5340358/
https://www.ncbi.nlm.nih.gov/pubmed/28267771
http://dx.doi.org/10.1371/journal.pone.0173374
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