Nationwide questionnaire survey of the contemporary surgical management of pancreatic cancer in the United Kingdom & Ireland

Abstract

This paper reports the results of a questionnaire-based survey of pancreatic surgical specialists in the United Kingdom addressing aspects of staging, resection volume and outcome. A postal survey was undertaken of the 517 members of the Association of upper Gastrointestinal Surgeons of Great Britain and Ireland (AUGIS). 57 surgeons undertook pancreatic resection from 162 overall respondents. Cross-checking with the list of members of the Pancreatic Society of Great Britain and Ireland yielded 64 pancreatic surgeons. 734 pancreaticoduodenectomy (PD) were reported by respondents compared with 822 procedures according to Government maintained Hospital Episode Statistics. The modal resection volume performed per annum was 6-10. There were 24 in-hospital deaths in 732 resections (3%) mortality. For individual respondents the modal percentage mortality was 5% (0 to 16%). All clinicians with mortality rates in excess of 10% did less than 10 resections per annum. Respondents favoured "amylase rich discharge beyond 7th post-operative day" as optimal for definition of post-resection pancreatic fistula. Accepting the limitations of questionnaire surveys, the results provide an important overview of pancreatic surgical practice: pancreaticoduodenectomy is carried out by a range of specialists, lower volume resectionists appear to have poorer outcomes and this study shows widespread agreement on optimum terminology for post-operative pancreatic fistula.