Ontology type: schema:ScholarlyArticle
2013-10-12
AUTHORSOdo Gangl, Klaus Sahora, Peter Kornprat, Christian Margreiter, Florian Primavesi, Evelyne Bareck, Martin Schindl, Friedrich Längle, Dietmar Öfner, Hans-Jörg Mischinger, Johann Pratschke, Michael Gnant, Reinhold Függer
ABSTRACTBackgroundDespite significant improvements in perioperative mortality as well as response rates to multimodality treatment, results after surgical resection of pancreatic adenocarcinoma with respect to long-term outcomes remain disappointing. Patient recruitment for prospective international trials on adjuvant and neoadjuvant regimens is challenging for various reasons. We set out to assess the preconditions and potential to perform perioperative trials for pancreatic cancer within a well-established Austrian nationwide network of surgical and medical oncologists (Austrian Breast & Colorectal Cancer Study Group).MethodsFrom 2005 to 2010 five high-volume centers and one medium-volume center completed standardized data entry forms with 33 parameters (history and patient related data, preoperative clinical staging and work-up, surgical details and intraoperative findings, postoperative complications, reinterventions, reoperations, 30-day mortality, histology, and timing of multimodality treatment). Outside of the study group, in Austria pancreatic resections are performed in three “high-volume” centers (>10 pancreatic resections per year), three “medium-volume” centers (5–10 pancreatic resections per year), and the rest in various low-volume centers (<5 pancreatic resections per year) in Austria. Nationwide data for prevalence of and surgical resections for pancreatic adenocarcinoma were contributed by the National Cancer Registry of Statistics of Austria and the Austrian Health Institute.ResultsIn total, 492 consecutive patients underwent pancreatic resection for ductal adenocarcinoma. All postoperative complications leading to hospital readmission were treated at the primary surgical department and documented in the database. Overall morbidity and pancreatic fistula rate were 45.5 % and 10.1 %, respectively. Within the entire cohort there were 9.8 % radiological reinterventions and 10.4 % reoperations. Length of stay was 16 days in median (0–209); 12 of 492 patients died within 30 days after operation, resulting in a 30-day mortality rate of 2.4 %. Seven of the total 19 deaths (36.8 %) occurred after 30 days, during hospitalization at the surgical department, resulting in a hospital mortality rate of 3.9 % (19/492). With a standardized histopathological protocol, there were 70 % (21/30) R0 resections, 30 % (9/30) R1 resections, and no R2 resections in Vienna and 62.7 % (32/51) R0 resections, 35.3 % (18/51) R1 resections, and 2 % (1/51) R2 resections in Salzburg. Resection margin status with nonstandardized protocols was classified as R0 in 82 % (339/411), R1 in 16 % (16/411), and R2 in 1.2 % (5/411). Perioperative chemotherapy was administered in 81.1 % of patients (8.3 % neoadjuvant; 68.5 % adjuvant; 4.3 % palliative); chemoradiotherapy (1.6 % neoadjuvant; 3 % adjuvant; 0.2 % palliative), in 4.9 % of patients. The six centers that contributed to this registry initiative provided surgical treatment to 40 % of all Austrian patients, resulting in a median annual recruitment of 85 (51–104) patients for the entire ABCSG-group and a median of 11.8 (0–38) surgeries for each individual department.ConclusionsSurgical quality data of the ABCSG core pancreatic group are in line with international standards. With continuing centralization the essential potential to perform prospective clinical trials for pancreatic adenocarcinoma is given in Austria. Several protocol proposals aiming at surgical and multimodality research questions are currently being discussed. More... »
PAGES456-462
http://scigraph.springernature.com/pub.10.1007/s00268-013-2283-3
DOIhttp://dx.doi.org/10.1007/s00268-013-2283-3
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PUBMEDhttps://www.ncbi.nlm.nih.gov/pubmed/24121365
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"description": "BackgroundDespite significant improvements in perioperative mortality as well as response rates to multimodality treatment, results after surgical resection of pancreatic adenocarcinoma with respect to long-term outcomes remain disappointing. Patient recruitment for prospective international trials on adjuvant and neoadjuvant regimens is challenging for various reasons. We set out to assess the preconditions and potential to perform perioperative trials for pancreatic cancer within a well-established Austrian nationwide network of surgical and medical oncologists (Austrian Breast & Colorectal Cancer Study Group).MethodsFrom 2005 to 2010 five high-volume centers and one medium-volume center completed standardized data entry forms with 33 parameters (history and patient related data, preoperative clinical staging and work-up, surgical details and intraoperative findings, postoperative complications, reinterventions, reoperations, 30-day mortality, histology, and timing of multimodality treatment). Outside of the study group, in Austria pancreatic resections are performed in three \u201chigh-volume\u201d centers (>10 pancreatic resections per year), three \u201cmedium-volume\u201d centers (5\u201310 pancreatic resections per year), and the rest in various low-volume centers (<5 pancreatic resections per year) in Austria. Nationwide data for prevalence of and surgical resections for pancreatic adenocarcinoma were contributed by the National Cancer Registry of Statistics of Austria and the Austrian Health Institute.ResultsIn total, 492 consecutive patients underwent pancreatic resection for ductal adenocarcinoma. All postoperative complications leading to hospital readmission were treated at the primary surgical department and documented in the database. Overall morbidity and pancreatic fistula rate were 45.5\u00a0% and 10.1\u00a0%, respectively. Within the entire cohort there were 9.8\u00a0% radiological reinterventions and 10.4\u00a0% reoperations. Length of stay was 16\u00a0days in median (0\u2013209); 12 of 492 patients died within 30\u00a0days after operation, resulting in a 30-day mortality rate of 2.4\u00a0%. Seven of the total 19 deaths (36.8\u00a0%) occurred after 30\u00a0days, during hospitalization at the surgical department, resulting in a hospital mortality rate of 3.9\u00a0% (19/492). With a standardized histopathological protocol, there were 70\u00a0% (21/30) R0 resections, 30\u00a0% (9/30) R1 resections, and no R2 resections in Vienna and 62.7\u00a0% (32/51) R0 resections, 35.3\u00a0% (18/51) R1 resections, and 2\u00a0% (1/51) R2 resections in Salzburg. Resection margin status with nonstandardized protocols was classified as R0 in 82\u00a0% (339/411), R1 in 16\u00a0% (16/411), and R2 in 1.2\u00a0% (5/411). Perioperative chemotherapy was administered in 81.1\u00a0% of patients (8.3\u00a0% neoadjuvant; 68.5\u00a0% adjuvant; 4.3\u00a0% palliative); chemoradiotherapy (1.6\u00a0% neoadjuvant; 3\u00a0% adjuvant; 0.2\u00a0% palliative), in 4.9\u00a0% of patients. The six centers that contributed to this registry initiative provided surgical treatment to 40\u00a0% of all Austrian patients, resulting in a median annual recruitment of 85 (51\u2013104) patients for the entire ABCSG-group and a median of 11.8 (0\u201338) surgeries for each individual department.ConclusionsSurgical quality data of the ABCSG core pancreatic group are in line with international standards. With continuing centralization the essential potential to perform prospective clinical trials for pancreatic adenocarcinoma is given in Austria. Several protocol proposals aiming at surgical and multimodality research questions are currently\u00a0being discussed.",
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27 | ″ | schema:description | BackgroundDespite significant improvements in perioperative mortality as well as response rates to multimodality treatment, results after surgical resection of pancreatic adenocarcinoma with respect to long-term outcomes remain disappointing. Patient recruitment for prospective international trials on adjuvant and neoadjuvant regimens is challenging for various reasons. We set out to assess the preconditions and potential to perform perioperative trials for pancreatic cancer within a well-established Austrian nationwide network of surgical and medical oncologists (Austrian Breast & Colorectal Cancer Study Group).MethodsFrom 2005 to 2010 five high-volume centers and one medium-volume center completed standardized data entry forms with 33 parameters (history and patient related data, preoperative clinical staging and work-up, surgical details and intraoperative findings, postoperative complications, reinterventions, reoperations, 30-day mortality, histology, and timing of multimodality treatment). Outside of the study group, in Austria pancreatic resections are performed in three “high-volume” centers (>10 pancreatic resections per year), three “medium-volume” centers (5–10 pancreatic resections per year), and the rest in various low-volume centers (<5 pancreatic resections per year) in Austria. Nationwide data for prevalence of and surgical resections for pancreatic adenocarcinoma were contributed by the National Cancer Registry of Statistics of Austria and the Austrian Health Institute.ResultsIn total, 492 consecutive patients underwent pancreatic resection for ductal adenocarcinoma. All postoperative complications leading to hospital readmission were treated at the primary surgical department and documented in the database. Overall morbidity and pancreatic fistula rate were 45.5 % and 10.1 %, respectively. Within the entire cohort there were 9.8 % radiological reinterventions and 10.4 % reoperations. Length of stay was 16 days in median (0–209); 12 of 492 patients died within 30 days after operation, resulting in a 30-day mortality rate of 2.4 %. Seven of the total 19 deaths (36.8 %) occurred after 30 days, during hospitalization at the surgical department, resulting in a hospital mortality rate of 3.9 % (19/492). With a standardized histopathological protocol, there were 70 % (21/30) R0 resections, 30 % (9/30) R1 resections, and no R2 resections in Vienna and 62.7 % (32/51) R0 resections, 35.3 % (18/51) R1 resections, and 2 % (1/51) R2 resections in Salzburg. Resection margin status with nonstandardized protocols was classified as R0 in 82 % (339/411), R1 in 16 % (16/411), and R2 in 1.2 % (5/411). Perioperative chemotherapy was administered in 81.1 % of patients (8.3 % neoadjuvant; 68.5 % adjuvant; 4.3 % palliative); chemoradiotherapy (1.6 % neoadjuvant; 3 % adjuvant; 0.2 % palliative), in 4.9 % of patients. The six centers that contributed to this registry initiative provided surgical treatment to 40 % of all Austrian patients, resulting in a median annual recruitment of 85 (51–104) patients for the entire ABCSG-group and a median of 11.8 (0–38) surgeries for each individual department.ConclusionsSurgical quality data of the ABCSG core pancreatic group are in line with international standards. With continuing centralization the essential potential to perform prospective clinical trials for pancreatic adenocarcinoma is given in Austria. Several protocol proposals aiming at surgical and multimodality research questions are currently being discussed. |
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34 | ″ | schema:keywords | Austria |
35 | ″ | ″ | Austrian Health Institute |
36 | ″ | ″ | Austrian patients |
37 | ″ | ″ | BackgroundDespite significant improvements |
38 | ″ | ″ | Cancer Registry |
39 | ″ | ″ | Department |
40 | ″ | ″ | Health Institute |
41 | ″ | ″ | Institute |
42 | ″ | ″ | MethodsFrom 2005 |
43 | ″ | ″ | National Cancer Registry |
44 | ″ | ″ | R0 |
45 | ″ | ″ | R0 resection |
46 | ″ | ″ | R1 |
47 | ″ | ″ | R1 resection |
48 | ″ | ″ | R2 |
49 | ″ | ″ | R2 resection |
50 | ″ | ″ | Registry Initiative |
51 | ″ | ″ | ResultsIn total |
52 | ″ | ″ | Salzburg |
53 | ″ | ″ | Vienna |
54 | ″ | ″ | adenocarcinoma |
55 | ″ | ″ | annual recruitment |
56 | ″ | ″ | cancer |
57 | ″ | ″ | cancer resection |
58 | ″ | ″ | center |
59 | ″ | ″ | centralization |
60 | ″ | ″ | chemoradiotherapy |
61 | ″ | ″ | chemotherapy |
62 | ″ | ″ | clinical trials |
63 | ″ | ″ | cohort |
64 | ″ | ″ | complications |
65 | ″ | ″ | consecutive patients |
66 | ″ | ″ | data |
67 | ″ | ″ | data entry forms |
68 | ″ | ″ | database |
69 | ″ | ″ | days |
70 | ″ | ″ | death |
71 | ″ | ″ | ductal adenocarcinoma |
72 | ″ | ″ | entire cohort |
73 | ″ | ″ | entry form |
74 | ″ | ″ | essential potential |
75 | ″ | ″ | fistula rate |
76 | ″ | ″ | form |
77 | ″ | ″ | group |
78 | ″ | ″ | high-volume centers |
79 | ″ | ″ | histopathological protocol |
80 | ″ | ″ | hospital mortality rate |
81 | ″ | ″ | hospital readmission |
82 | ″ | ″ | hospitalization |
83 | ″ | ″ | improvement |
84 | ″ | ″ | individual departments |
85 | ″ | ″ | initiatives |
86 | ″ | ″ | international standards |
87 | ″ | ″ | international trial |
88 | ″ | ″ | length |
89 | ″ | ″ | length of stay |
90 | ″ | ″ | lines |
91 | ″ | ″ | long-term outcomes |
92 | ″ | ″ | low-volume centers |
93 | ″ | ″ | margin status |
94 | ″ | ″ | median |
95 | ″ | ″ | medical oncologists |
96 | ″ | ″ | medium-volume centers |
97 | ″ | ″ | morbidity |
98 | ″ | ″ | mortality |
99 | ″ | ″ | mortality rate |
100 | ″ | ″ | multimodality treatment |
101 | ″ | ″ | national initiatives |
102 | ″ | ″ | nationwide data |
103 | ″ | ″ | nationwide network |
104 | ″ | ″ | neoadjuvant regimens |
105 | ″ | ″ | network |
106 | ″ | ″ | nonstandardized protocols |
107 | ″ | ″ | oncologists |
108 | ″ | ″ | operation |
109 | ″ | ″ | outcomes |
110 | ″ | ″ | overall morbidity |
111 | ″ | ″ | pancreatic adenocarcinoma |
112 | ″ | ″ | pancreatic cancer |
113 | ″ | ″ | pancreatic cancer resection |
114 | ″ | ″ | pancreatic fistula rate |
115 | ″ | ″ | pancreatic group |
116 | ″ | ″ | pancreatic resection |
117 | ″ | ″ | parameters |
118 | ″ | ″ | patient recruitment |
119 | ″ | ″ | patients |
120 | ″ | ″ | perioperative chemotherapy |
121 | ″ | ″ | perioperative mortality |
122 | ″ | ″ | perioperative trials |
123 | ″ | ″ | postoperative complications |
124 | ″ | ″ | potential |
125 | ″ | ″ | precondition |
126 | ″ | ″ | prevalence |
127 | ″ | ″ | proposal |
128 | ″ | ″ | prospective clinical trials |
129 | ″ | ″ | prospective international trials |
130 | ″ | ″ | protocol |
131 | ″ | ″ | protocol proposal |
132 | ″ | ″ | quality data |
133 | ″ | ″ | questions |
134 | ″ | ″ | rate |
135 | ″ | ″ | readmission |
136 | ″ | ″ | reasons |
137 | ″ | ″ | recruitment |
138 | ″ | ″ | regimens |
139 | ″ | ″ | registry |
140 | ″ | ″ | reintervention |
141 | ″ | ″ | reoperation |
142 | ″ | ″ | research questions |
143 | ″ | ″ | resection |
144 | ″ | ″ | resection margin status |
145 | ″ | ″ | respect |
146 | ″ | ″ | response rate |
147 | ″ | ″ | rest |
148 | ″ | ″ | results |
149 | ″ | ″ | significant improvement |
150 | ″ | ″ | standardized data entry form |
151 | ″ | ″ | standards |
152 | ″ | ″ | statistics |
153 | ″ | ″ | status |
154 | ″ | ″ | stay |
155 | ″ | ″ | study group |
156 | ″ | ″ | surgery |
157 | ″ | ″ | surgical department |
158 | ″ | ″ | surgical resection |
159 | ″ | ″ | surgical treatment |
160 | ″ | ″ | total |
161 | ″ | ″ | treatment |
162 | ″ | ″ | trials |
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