Nordby Tom, Ikdahl Tone, Lothe Inger Marie Bowitz, Ånonsen Kim, Hauge Truls, Edwin Bjørn, Line Pål-Dag, Labori Knut Jørgen, Buanes Trond
Department of Gastroenterological Surgery, Division of Cancer, Surgery and Transplantation, Oslo University Hospital (OuS), Oslo, Norway.
Scand J Gastroenterol. 2013 May;48(5):617-25. doi: 10.3109/00365521.2013.781218.
Abstract Objective. The first objective of the present study was to identify opportunities of improvement for clinical practice, assessed by local quality indicators, then to analyze possible reasons why we did not reach defined treatment quality measures. The second objective was to characterize patients, considered unresectable according to present criteria, for future arrangement of interventional studies with improved patient selection. Material and methods. Prospective observational cohort study from October 2008 to December 2010 of patients referred to the authors' institution with suspected pancreatic or periampullary neoplasm. Results. Of 330 patients, 135 underwent surgery, 195 did not, 129 due to unresectable malignancies. The rest had benign lesions. Perioperative morbidity rate was 32.6%, mortality 0.7%. Radical resection (R0) was obtained in 23 (41.8%) of 55 patients operated for pancreatic adenocarcinoma and 6.3% underwent reconstructive vascular surgery. Diagnostic failure/delay resulted in unresectable carcinoma, primarily misconceived as serous cystic adenoma in two patients. One resected lesion turned out to be focal autoimmune pancreatitis. One case with misdiagnosed cancer was revised to be a pseudoaneurysm. Palliative treatment was offered to 144 patients with malignant tumors, 62 due to locally advanced disease and all pancreatic adenocarcinomas. Conclusions. Quality improvement opportunities were identified for patient selection and surgical technique: Too few patients underwent reconstructive vascular surgery. The most important quality indicators are those securing resectional, radical (R0) surgery. Altogether 143 patients (57.9%) of those with malignant tumors were found unresectable, most of these patients are eligible for inclusion in future interventional studies with curative and/or palliative intention.
摘要 目的。本研究的首要目的是通过当地质量指标确定临床实践的改进机会，然后分析未达到既定治疗质量指标的可能原因。第二个目的是对根据当前标准被认为无法切除的患者进行特征描述，以便为未来改进患者选择的干预性研究做出安排。材料与方法。对2008年10月至2010年12月转诊至作者所在机构疑似胰腺或壶腹周围肿瘤的患者进行前瞻性观察队列研究。结果。330例患者中，135例接受了手术，195例未接受手术，其中129例因恶性肿瘤无法切除。其余为良性病变。围手术期发病率为32.6%，死亡率为0.7%。55例接受胰腺癌手术的患者中有23例（41.8%）实现了根治性切除（R0），6.3%的患者接受了血管重建手术。诊断失败/延迟导致癌无法切除，主要是两名患者被误诊为浆液性囊腺瘤。1例切除的病变后来被证实为局灶性自身免疫性胰腺炎。1例误诊为癌症的病例后来被修正为假性动脉瘤。144例恶性肿瘤患者接受了姑息治疗，其中62例因局部晚期疾病以及所有胰腺癌患者。结论。在患者选择和手术技术方面确定了质量改进机会：接受血管重建手术的患者太少。最重要的质量指标是确保进行切除性、根治性（R0）手术的指标。总共143例（57.9%）恶性肿瘤患者被发现无法切除，这些患者中的大多数有资格纳入未来具有治愈和/或姑息意图的干预性研究。
