Aim: To evaluate the impact of multidisciplinary team case discussion including computed tomography (CT) radiologic review on surgical outcome and overall survival (OS) of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: Patients with PDAC evaluated in 2008–2011 and 2013–2016 (before and after multidisciplinary team introduction), aged <85 years and staged I–III, were included. Surgical failures and 2-year OS were compared in these periods. Available CT scans of preintervention period (2008–2011) cases were reviewed by two radiologists in consensus, assigning a resectability judgment to evaluate in how many cases a different recommendation would be achieved. Results: A total of 316 patients (49.3% female, age 71±10 years) were included: 132 in 2008–2011 and 184 in 2013–2016. The proportion of patients who underwent upfront surgery was similar in the two periods (51% vs 47% in 2008–2011 vs 2013–2016). Neoadjuvant referral increased from 7% to 21% and surgical resection was excluded for 42% patients in 2008–2011 vs 33% in 2013–2016 (p = 0.002). Adjusting by age, sex, and stage, surgical failures slightly decreased in 2013–2016 (odds ratio 0.89, 95% confidence interval 0.53–1.51); the decrease was stronger when therapeutic choice complied with CT indications (odds ratio 0.76, 95% confidence interval 0.36–1.63); in both cases, the decrease could be due to chance. After correction for age, sex, and stage, the hazard ratio of 2013–2016 for OS was 0.83 (95% confidence interval 0.64–1.09). In 33/114 (29%) patients, CT retrospective review produced a change in resectability judgment. Conclusion: Although differences could be due to chance or generic improvement, the consistency between process and outcome indicators suggests that multidisciplinary team approach with radiologic review may improve outcomes.

Impact of multidisciplinary approach and radiologic review on surgical outcome and overall survival of patients with pancreatic cancer: a retrospective cohort study / Artioli, G.; Besutti, G.; Cassetti, T.; Sereni, G.; Zizzo, M.; Bonacini, S.; Carlinfante, G.; Panebianco, M.; Cavazza, A.; Pinto, C.; Sassatelli, R.; Pattacini, P.; Giorgi Rossi, P.. - In: TUMORI. - ISSN 0300-8916. - 108:2(2022), pp. 147-156. [10.1177/0300891621999092]

Impact of multidisciplinary approach and radiologic review on surgical outcome and overall survival of patients with pancreatic cancer: a retrospective cohort study

Artioli G.;Besutti G.;Zizzo M.;Cavazza A.;
2022

Abstract

Aim: To evaluate the impact of multidisciplinary team case discussion including computed tomography (CT) radiologic review on surgical outcome and overall survival (OS) of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: Patients with PDAC evaluated in 2008–2011 and 2013–2016 (before and after multidisciplinary team introduction), aged <85 years and staged I–III, were included. Surgical failures and 2-year OS were compared in these periods. Available CT scans of preintervention period (2008–2011) cases were reviewed by two radiologists in consensus, assigning a resectability judgment to evaluate in how many cases a different recommendation would be achieved. Results: A total of 316 patients (49.3% female, age 71±10 years) were included: 132 in 2008–2011 and 184 in 2013–2016. The proportion of patients who underwent upfront surgery was similar in the two periods (51% vs 47% in 2008–2011 vs 2013–2016). Neoadjuvant referral increased from 7% to 21% and surgical resection was excluded for 42% patients in 2008–2011 vs 33% in 2013–2016 (p = 0.002). Adjusting by age, sex, and stage, surgical failures slightly decreased in 2013–2016 (odds ratio 0.89, 95% confidence interval 0.53–1.51); the decrease was stronger when therapeutic choice complied with CT indications (odds ratio 0.76, 95% confidence interval 0.36–1.63); in both cases, the decrease could be due to chance. After correction for age, sex, and stage, the hazard ratio of 2013–2016 for OS was 0.83 (95% confidence interval 0.64–1.09). In 33/114 (29%) patients, CT retrospective review produced a change in resectability judgment. Conclusion: Although differences could be due to chance or generic improvement, the consistency between process and outcome indicators suggests that multidisciplinary team approach with radiologic review may improve outcomes.
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Impact of multidisciplinary approach and radiologic review on surgical outcome and overall survival of patients with pancreatic cancer: a retrospective cohort study / Artioli, G.; Besutti, G.; Cassetti, T.; Sereni, G.; Zizzo, M.; Bonacini, S.; Carlinfante, G.; Panebianco, M.; Cavazza, A.; Pinto, C.; Sassatelli, R.; Pattacini, P.; Giorgi Rossi, P.. - In: TUMORI. - ISSN 0300-8916. - 108:2(2022), pp. 147-156. [10.1177/0300891621999092]
Artioli, G.; Besutti, G.; Cassetti, T.; Sereni, G.; Zizzo, M.; Bonacini, S.; Carlinfante, G.; Panebianco, M.; Cavazza, A.; Pinto, C.; Sassatelli, R.; Pattacini, P.; Giorgi Rossi, P.
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Utilizza questo identificativo per citare o creare un link a questo documento: http://hdl.handle.net/11380/1274764
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