Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. BJS 2019; 106: 756-764.
Published: 4th March 2019
Authors: J. Kirkegård, E. K. Aahlin, M. Al‐Saiddi, S. O. Bratlie, M. Coolsen, R. J. de Haas et al.
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.
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 information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals.
A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.
Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.Full text
You may also be interested in
Clinical value of additional resection of a margin‐positive distal bile duct in perihilar cholangiocarcinoma. BJS 2019; 106: 774-782.
Authors: S. Otsuka, T. Ebata, Y. Yokoyama, T. Mizuno, T. Tsukahara, Y. Shimoyama et al.
Authors: W. S. Tummers, J. V. Groen, B. G. Sibinga Mulder, A. Farina‐Sarasqueta, J. Morreau, H. Putter et al.
Outcomes following pancreatic surgery using three different thromboprophylaxis regimens. BJS 2019; 106: 765-773.
Authors: R. G. Hanna‐Sawires, J. V. Groen, F. A. Klok, R. A. E. M. Tollenaar, W. E. Mesker, R. J. Swijnenburg et al.
Major hepatectomy with or without pancreatoduodenectomy for advanced gallbladder cancer. BJS 2019; 106: 626-635.
Authors: T. Mizuno, T. Ebata, Y. Yokoyama, T. Igami, J. Yamaguchi, S. Onoe et al.
Systematic review of clinical prediction models for survival after surgery for resectable pancreatic cancer. BJS 2019; 106: 342-354.
Authors: M. Strijker, J. W. Chen, T. H. Mungroop, N. B. Jamieson, C. H. van Eijck, E. W. Steyerberg et al.
Randomized clinical trial
Randomized trial of oral versus enteral feeding for patients with postoperative pancreatic fistula after pancreatoduodenectomy. BJS 2019; 106: 190-198.
Authors: J.‐M. Wu, T.‐C. Kuo, H.‐A. Chen, C.‐H. Wu, S.‐R. Lai, C.‐Y. Yang et al.
Clinical and experimental studies of intraperitoneal lipolysis and the development of clinically relevant pancreatic fistula after pancreatic surgery. BJS 2019; 106: 616-625.
Authors: Y. Uchida, T. Masui, K. Nakano, A. Yogo, A. Sato, K. Nagai et al.
Authors: T. M. Mackay, U. F. Wellner, L. B. van Rijssen, T. F. Stoop, O. R. Busch, B. Groot Koerkamp et al.
Multicentre propensity score‐matched study of laparoscopic versus open repeat liver resection for colorectal liver metastases. BJS 2019; 106: 783-789.
Authors: M. J. van der Poel, L. Barkhatov, D. Fuks, G. Berardi, F. Cipriani, A. Aljaiuossi et al.
Proposal for a new classification for perihilar cholangiocarcinoma based on tumour depth. BJS 2019; 106: 427-435.
Authors: K. Shinohara, T. Ebata, Y. Shimoyama, M. Nakaguro, T. Mizuno, K. Matsuo et al.
Systematic review of the quantity and quality of randomized clinical trials in pancreatic surgery. BJS 2019; 106: 23-31.
Authors: F. J. Hüttner, L. Capdeville, F. Pianka, A. Ulrich, T. Hackert, M. W. Büchler et al.
Systematic review of management of incidental gallbladder cancer after cholecystectomy. BJS 2019; 106: 32-45.
Authors: K. Søreide, R. V. Guest, E. M. Harrison, T. J. Kendall, O. J. Garden, S. J. Wigmore et al.