Department of Surgery, Rigshospitalet, Copenhagen University Hospital, Denmark.
Int J Surg. 2020 May;77:105-110. doi: 10.1016/j.ijsu.2020.03.045. Epub 2020 Mar 28.
Centralization has improved the outcome of complex operations including cancer surgery. Moreover, the implementation of multidisciplinary team conferences (MDT) has ameliorated the decision making, but the impact on patient outcome is controversial. The aim of the study was to investigate the outcome of pancreatic surgery in the setting of centralization and upfront multidisciplinary decision making.
The decisions of MDT from 2010 to 2016 and the outcome of operations were compared with operations from 2003 to 2009 before centralization of pancreatic surgery and implementation of MDT. Data were drawn from the department's database and from hospital's electronic patient files.
From 2010 to 2016, 7.015 patients were evaluated at the MDT. In 72.6% of patients a treatment plan followed the first evaluation, the referral diagnosis was changed in 12.4% of cases. Of 3.362 solid neoplasms, 1.680 (50.0%) were evaluated as resectable and 1.080 (32.1%) patients were operated. The annual resection rate of operated patients was78.3%-88.5% (median 80.0%) compared to 21.4% to 80.% (median 68.6%, p = 0.0001) from 2003 to 2009 with 279 operated patients. The post-operative 30 - and 90-days mortality from 2003 to 2009 and 2010 to 2016 was 3.4% vs. 1.8% (NS) and 5.0% vs 3.6% (NS). In the same periods explorative laparotomies and palliative resections decreased from 18.3% to 3.6% (p = 0.0001) and 18.6%-10.2% (p = 0.0002). The median survival of radically resected pancreatic adenocarcinoma (PAC) from 2003 to 2009 and from 2010 to 2016 was 20.2 and 21.9 months, respectively (p = 0.687).
The MDT increased patient flow, improved quality of decision-making and offered more patients surgical treatment without increasing morbidity or mortality. But an impact on the long-term survival of patients with PAC was not found.
集中化已经改善了包括癌症手术在内的复杂手术的结果。此外，多学科团队会议（MDT）的实施改善了决策，但对患者预后的影响仍存在争议。本研究旨在调查集中化和多学科决策制定对胰腺手术结果的影响。
比较了 2010 年至 2016 年 MDT 的决策和手术结果与胰腺手术集中化和 MDT 实施前的 2003 年至 2009 年的手术结果。数据来自科室数据库和医院电子病历。
2010 年至 2016 年，MDT 评估了 7015 例患者。在 72.6%的患者中，首次评估后制定了治疗计划，12.4%的患者转诊诊断发生了改变。3362 例实体肿瘤中，1680 例（50.0%）评估为可切除，1080 例（32.1%）患者接受了手术。接受手术的患者的年切除率为 78.3%-88.5%（中位数为 80.0%），而 2003 年至 2009 年为 21.4%-80.0%（中位数为 68.6%，p=0.0001），接受手术的患者为 279 例。2003 年至 2009 年和 2010 年至 2016 年的术后 30 天和 90 天死亡率分别为 3.4%和 1.8%（NS）和 5.0%和 3.6%（NS）。同期探查性剖腹手术和姑息性切除术分别从 18.3%降至 3.6%（p=0.0001）和 18.6%-10.2%（p=0.0002）。2003 年至 2009 年和 2010 年至 2016 年根治性切除的胰腺腺癌（PAC）的中位生存期分别为 20.2 个月和 21.9 个月（p=0.687）。
MDT 增加了患者流量，改善了决策质量，并为更多患者提供了手术治疗，而不会增加发病率或死亡率。但对 PAC 患者的长期生存没有影响。
