Kyoichi Takaori1, Claudio Bassi2, Andrew Biankin3, Thomas B Brunner4, Ivana Cataldo5, Fiona Campbell6, David Cunningham7, Massimo Falconi8, Adam E Frampton9, Junji Furuse10, Marc Giovannini11, Richard Jackson12, Akira Nakamura13, William Nealon14, John P Neoptolemos12, Francisco X Real15, Aldo Scarpa5, Francesco Sclafani7, John A Windsor16, Koji Yamaguchi17, Christopher Wolfgang18, Colin D Johnson19. 1. Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: takaori@kuhp.kyoto-u.ac.jp. 2. Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy. 3. Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom. 4. Department of Radiation Oncology, University Hospitals Freiburg, Germany. 5. Department of Pathology and Diagnostics, University of Verona, Verona, Italy. 6. Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom. 7. Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom. 8. Pancreatic Surgery Unit, Università Vita e Salute, Milano, Italy. 9. HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, United Kingdom. 10. Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan. 11. Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France. 12. NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom. 13. Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan. 14. Division of General Surgery, Yale University, New Haven, CT, United States of America. 15. Epithelial Carcinogenesis Group, CNIO-Spanish National Cancer Research Centre, Madrid, Spain. 16. Department of Surgery, University of Auckland, HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand. 17. Department of Advanced Treatment of Pancreatic Disease, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan. 18. Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States of America. 19. University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom.
Abstract
BACKGROUND: Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. METHODS: A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent. RESULTS: Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines. CONCLUSION: The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
BACKGROUND:Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies. METHODS: A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent. RESULTS: Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines. CONCLUSION: The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
Authors: Alex Mirnezami; Ben Knight; Brendan Moran; Fergus Noble; Graham Branagan; John Primrose; Katherine Pearson; Malcolm West; Nathan Curtis; Phil Pucher; Ramsey Cuttress; Sian Pugh; Tim Underwood Journal: Ann R Coll Surg Engl Date: 2019-07-30 Impact factor: 1.891
Authors: Loveena Sreedharan; Bhaskar Kumar; Anna Jewell; Paul Banim; Andreas Koulouris; Andrew R Hart Journal: Frontline Gastroenterol Date: 2018-10-09
Authors: Carsten Palnæs Hansen; Jan Henrik Storkholm; Martin Hylleholt Sillesen; Paul Suno Krohn; Stefan Kobbelgaard Burgdorf; Jens Georg Hillingsø Journal: BMC Surg Date: 2022-05-21 Impact factor: 2.030