Hepatopancreaticobiliary Surgery, The Alfred Hospital, Melbourne, Victoria, Australia.
Department of Surgery, Central Clinical School, Monash University, Victoria, Australia.
ANZ J Surg. 2023 Nov;93(11):2638-2647. doi: 10.1111/ans.18522. Epub 2023 May 23.
The Victorian Government convened the second Pancreas Cancer Summit in 2021 to identify unwarranted variation in care 2016-2019, and to assess trends compared with the first Summit 2017 (reporting 2011-2015). State-wide administrative data were assessed at population level in alignment with optimal care pathways across all stages of the cancer care continuum.
Data linkage performed by Centre for Victorian Data Linkage combined data from Victorian Cancer Registry with other administrative data sets including Victorian Admitted Episodes Dataset, Victorian Radiotherapy Minimum Data Set, Victorian Emergency Minimum Dataset and Victorian Death Index. A Cancer Service Performance Indicator audit was carried out providing an in-depth analysis of identified areas of interest.
Of 3138 Victorians diagnosed with pancreas ductal adenocarcinoma 2016-2019, 63% were metastatic at diagnosis. One-year survival increased between time periods, from 29.7% overall 2011-2015 (59.1% for non-metastatic, and 15.1% metastatic) to 32.5% overall 2016-2019 (P < 0.001), 61.2% non-metastatic (P = 0.008), 15.7% metastatic (P = NS). A higher proportion of non-metastatic patients progressed to surgery (35% vs. 31%, P = 0.020), and more received neoadjuvant therapy (16% vs. 4%, P < 0.001). Postoperative mortality following pancreatectomy at 30 and 90 days remained low at 2%. Utilization of 5FU-based chemotherapy regimens increased between 2016 and 2020. Multidisciplinary Meeting (MDM) presentation was still below the 85% target (74%) as was supportive care screening (39%, target 80%).
Surgical outcomes remain world-class and there has been an appropriate shift in chemotherapy administration towards neoadjuvant timing with increasing use of 5FU-based regimens. MDM presentation rates, supportive care and overall care coordination remain areas of deficiency.
2021 年，维多利亚州政府召开了第二次胰腺癌峰会，以确定 2016-2019 年护理方面的不必要差异，并评估与 2017 年第一次峰会（报告 2011-2015 年）相比的趋势。在整个癌症护理连续体的所有阶段，根据最佳护理途径，在人群水平上评估全州范围内的行政数据。
维多利亚州数据链接中心通过数据链接，将维多利亚癌症登记处的数据与其他行政数据集（包括维多利亚州入院病例数据集、维多利亚州放射治疗最低数据集、维多利亚州紧急情况最低数据集和维多利亚州死亡指数）相结合。进行了癌症服务绩效指标审计，对确定的感兴趣领域进行了深入分析。
在 2016-2019 年期间诊断出的 3138 名患有胰腺导管腺癌的维多利亚人中，63%在诊断时已经转移。一个时期内，1 年生存率有所提高，从 2011-2015 年的总体 29.7%（非转移性为 59.1%，转移性为 15.1%）上升到 2016-2019 年的总体 32.5%（P<0.001），非转移性为 61.2%（P=0.008），转移性为 15.7%（P=NS）。更多的非转移性患者进展到手术（35%比 31%，P=0.020），并且更多的患者接受了新辅助治疗（16%比 4%，P<0.001）。30 天和 90 天胰腺切除术后的术后死亡率仍然很低，为 2%。2016 年至 2020 年间，5FU 为基础的化疗方案的使用有所增加。多学科会议（MDM）的呈现率仍低于 85%的目标（74%），支持性护理筛查率（39%，目标 80%）也是如此。
手术结果仍然是世界级的，并且化疗管理朝着新辅助治疗的时机发生了适当的转变，5FU 为基础的方案的使用也有所增加。MDM 呈现率、支持性护理和整体护理协调仍然是不足之处。
