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Implementation of a strategic preoperative surgical meeting to improve the level of care at a high-volume pancreatic center: a before–after analysis of 1000 consecutive cases

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Abstract

The indication, planning, and risk analysis of a pancreatic surgical procedure have recently become increasingly complex. In December 2015, the “Pancreas Round” (PR) meeting was established at our institution to preoperatively review all scheduled cases with a specific focus on surgical indications and technical issues. The present study aims to determine the impact of the PR on the clinical practice in terms of avoiding unrequested laparotomies and anticipating intraoperative pitfalls. A “before–after” study was conducted by retrospectively comparing a pre-intervention period (9/2014–11/2015) to a prospectively assessed post-intervention one (12/2015–3/2017). Outcomes considered were explorative laparotomy (EL) occurrence and a “mismatch” between what was preoperatively expected by the PR and what was intraoperatively found. Of the 1057 patients included in the present study, 531 underwent surgery in the pre- and 526 in the post-intervention period, respectively. The EL rate was comparable between the two periods (15.4% vs. 12.2%, p = 0.123), despite the significant increase of surgical explorations after neoadjuvant chemotherapy during the post-intervention period (27% vs. 18%, p < 0.001). The “mismatch” rate between preoperative planning and intraoperative findings was significantly reduced in the post-intervention period (12.2% vs. 8.4%, p = 0.038) compared to the pre-PR period. In the setting of a high-volume center, a preoperative surgical meeting designed to review all cases scheduled for surgical exploration can enhance the level of care by addressing intraoperative pitfalls.

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Acknowledgements

SPaRo Group (Surgical Pancreas Round Group) members: Prof. C. Bassi, Prof R. Salvia, L. Casetti MD, A. Esposito MD, M. Fontana MD, L. Landoni MD, G. Malleo MD, G. Marchegiani MD, S. Paiella MD, A. Pea MD, M. Tuveri MD, M. De Pastena MD, H. Impellizzeri MD, L. Maggino MD, R. Piccolo MD, V. Todaro MD, F. Accordini MD, V. Allegrini MD, S. Andrianello MD, A. Bunicci MD, I. Damoli MD, E. Marrano MD, M. Miotto MD, A. Pulvirenti MD, M. Ramera MD, A. Borin MD, C. Dal Borgo MD, G. Perri MD, E.Viviani MD, C.C. Zingaretti MD, E. Bannone MD, A. Balduzzi MD, D. Ciprani MD, L. Crepaz MD, T. Giuliani MD, G. Masini MD, C. Nessi MD, N. Surci MD, L. Bertoldi MD, C. Bortolato MD, F. Casciani MD, A. Di Gioia MD, S. Nobile MD, E. Sereni MD. Special guests of the Meeting as “visiting Professor” during the present study period: Prof. M. Adham (University of Lyon), Prof. H. Friess (University of Munich), Prof. J.P. Neoptolemos (University of Heidelberg), Prof. C.L. Wolfgang (Johns Hopkins University School of Medicine-Baltimore).

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Authors and Affiliations

  1. Department of General and Pancreatic Surgery, Pancreas Institute, University and Hospital Trust of Verona, “GB Rossi” Hospital, University of Verona, Piazzale L.A. Scuro, 10, 37134, Verona, Italy

    Niccolò Surci, Marco Ramera, Alex Borin, Giovanni Marchegiani, Roberto Salvia & Claudio Bassi

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  1. Niccolò Surci
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  2. Marco Ramera
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  3. Alex Borin
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  4. Giovanni Marchegiani
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Consortia

SPaRo Group

  • C. Bassi
  • , R. Salvia
  • , L. Casetti
  • , A. Esposito
  • , M. Fontana
  • , L. Landoni
  • , G. Malleo
  • , G. Marchegiani
  • , S. Paiella
  • , A. Pea
  • , M. Tuveri
  • , M. De Pastena
  • , H. Impellizzeri
  • , L. Maggino
  • , R. Piccolo
  • , V. Todaro
  • , F. Accordini
  • , V. Allegrini
  • , S. Andrianello
  • , A. Bunicci
  • , I. Damoli
  • , E. Marrano
  • , M. Miotto
  • , A. Pulvirenti
  • , M. Ramera
  • , A. Borin
  • , C. Dal Borgo
  • , G. Perri
  • , E. Viviani
  • , C. C. Zingaretti
  • , E. Bannone
  • , A. Balduzzi
  • , D. Ciprani
  • , L. Crepaz
  • , T. Giuliani
  • , G. Masini
  • , C. Nessi
  • , N. Surci
  • , L. Bertoldi
  • , C. Bortolato
  • , F. Casciani
  • , A. Di Gioia
  • , S. Nobile
  • , E. Sereni
  • , M. Adham
  • , H. Friess
  • , J. P. Neoptolemos
  •  & C. L. Wolfgang

Corresponding author

Correspondence to Claudio Bassi.

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The authors declare that they have no conflict of interest.

Ethical approval

All procedures performed in studies involving human participants were in accordance with the ethical standards of the national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.

Human and animal rights

This article does not contain any studies with animals performed by any of the authors. As this study is designed as a retrospective study, formal consent is not required.

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As data were collected as part of a regular hospital stay and analyzed retrospectively, informed consent was not obtained. The study was approved by the local ethics committee and registered with ClinicalTrial.gov. Trial registration number: NCT03807687.

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Surci, N., Ramera, M., Borin, A. et al. Implementation of a strategic preoperative surgical meeting to improve the level of care at a high-volume pancreatic center: a before–after analysis of 1000 consecutive cases. Updates Surg 72, 155–161 (2020). https://doi.org/10.1007/s13304-020-00707-8

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