12
GENERAL SURGERY NEWS / NOVEMBER 2021
Better Outcomes in Pancreatic Cancer The National Pancreas Foundation Centers of Excellence Program Dr. Lisandro Montorfano, a PGY-4 surgical resident at Cleveland Clinic Florida, Weston, interviews hepatobiliary surgeon Dr. Mayank Roy, and medical oncologist Dr. Arun Nagarajan.
Welcome to the November issue of The Surgeons’ Lounge. We dedicate this issue to the National Pancreas Foundation (NPF) Centers of Excellence program that uses a multidisciplinary team approach to achieve better outcomes for patients with pancreatic cancer. Mayank Roy, MD, a hepatobiliary surgeon, and Arun Nagarajan, MD, a medical oncologist, both at Cleveland Clinic Florida, in Weston, provide up-todate answers to the most common questions regarding the NPF Centers of Excellence for pancreatic cancer. Also in this issue, you will find another installment of “The Instrument, the Name,” featuring the Thompson Retractor. We look forward to our readers’ questions, comments and interesting cases to present. Sincerely, Samuel Szomstein, MD, FACS ACS Editor, The Surgeons’ Lounge Szomsts@ccf.org
Pancreatic centers of excellence can act as a guide for these patients, where they can get high-quality care for pancreatic cancer without traveling long distances. —Mayank Roy, MD and Arun Nagarajan, MD
Dr. Montorfano: What are some wide geographic distances create a challenge. From a new advances in pancreatic cancer patient’s perspective, they often do not want to travel long treatment? distances for their treatment. Pancreatic Centers of ExcelDrs. Roy and Nagarajan: More than 60,000 peolence can act as a guide for these patients, where they ple will be diagnosed with pancreatic cancer, and can get high-quality care for pancreatic cancer withmore than 48,000 people will die from the disease out traveling long distances. in the United States in 2021. Traditionally, surWhat is the reaction of your patients when gical resection has been the cornerstone of treatyou explain to them what the NPF program ment for resectable pancreatic cancer. However, entails? Dr. Mayank Roy the prognosis remains poor. The addition of chemotherapy, and in some cases, radiation, Drs. Roy and Nagarajan: From a patient’s improves survival. Recent trials have looked at perspective, they may not understand the concept the sequence of treatment to compare adjuvant of Centers of Excellence. Although we cannot and neoadjuvant therapy. In addition, in the last provide solid evidence of better outcomes solely decade, genetic analysis and immune therapy based on the programs themselves, the fact that the have been the topics of interest for researchfundamentals of these programs are based on Dr. Mayank Roy ers and clinicians. While immune therapy high volume, expertise and a multidisciplinary on its own has not shown improved survivapproach allows patients to feel satisfied with al in pancreatic cancer because of a very resistant tumor and confident in their treatment. microenvironment, it has shown some promising results in Are pancreatic cancer outcomes improving nationwide combination treatment. since the program has been implemented? What is the National Pancreas Foundation (NPF) Drs. Roy and Nagarajan: Outcomes in the form of Centers of Excellence program for pancreatic cancer? complications and survival for pancreatic cancer have Drs. Roy and Nagarajan: The NPF Centers of Excel- been shown to be better in high-volume centers. Some of lence program is a charitable organization set up in 1997, the criteria for Centers of Excellence for pancreatic canto provide resources to patients and their families affect- cer involve volume and expertise (e.g., a minimum of >100 ed by pancreatic disease. The Centers of Excellence pro- ERCPs, >100 endoscopic ultrasound procedures and >12 gram provides research funds, advocates for new therapies, pancreticodudoenectomies a year, and a gastroenterologist and provides education for patients and physicians, and is and surgeon with >5 years of experience). Although the one of the pillars of the NPF. Centers of excellence are Centers of Excellence concept is still a relatively new conpremier health facilities located throughout the Unit- cept with minimal data, the fundamentals on which it is ed States. These centers can provide pancreatic cancer based will translate into better outcomes. patients with specialists to help with the diagnosis and treatment, including surgery. In addition, they can help Are similar Centers of Excellence program guidelines patients with overall management, including pain, nutri- being implemented in the rest of the world? tion and psychosocial support. Drs. Roy and Nagarajan: The NPF gives accreditation to centers located in the United States. As mentioned earHow is the program structured? What specialties does lier, most European models have already shifted toward it involve? How do hospitals become members of this centralization of care for pancreatic cancer. prestigious program? Drs. Roy and Nagarajan: Centers of Excellence for Are the standards of the NPF program reproducible in pancreatic cancer are selected based on the criteria devel- rural and community hospitals? oped by experts in the field, with a high-level focus on Drs. Roy and Nagarajan: Presumably, if rural and commultidisciplinary treatment of pancreatic cancer. This munity hospitals can meet all of the requirements and criteinvolves active participation of pancreatic surgeons, gas- ria deemed essential by NPF experts, then they can provide troenterologists, medical oncologists, endocrinologists, the same high standard of quality care to pancreatic cancer radiation oncologists, pathologists, radiologists and genet- patients, similar to other Centers of Excellence. ■ ics specialists through a biweekly multidisciplinary gastroenterology tumor board. The program should be able Suggested Reading to support next-generation sequencing and molecular and Fogel EL, Shahda S, Sandrasegaran K, et al. A multidisciplinary approach to pancreas cancer in 2016: a review. Am J Gastroenterol. genomic profiling. In addition, nutritional support, pal- 2017;112(4):537-554. liative care and psychosocial support should be available. Oba A, Ho F, Bao QR, et al. Neoadjuvant treatment in pancreatic cancer. Hospitals can apply if they meet all these criteria through Front Oncol. 202;10:245. a yearly application. Parekh HD, Starr J, George TJ Jr. The multidisciplinary approach What is the benefit of implementing the NPF Centers of Excellence program for pancreatic cancer? Drs. Roy and Nagarajan: Most European models have moved toward centralizing pancreatic cancer care around state-of-the art referral centers where a multidisciplinary approach is used to manage the patients. Although we are slowly adopting these changes in the United States model,
to localized pancreatic adenocarcinoma. Curr Treat Options Oncol. 2017;18(12):73. Roth MT, Cardin DB, Berlin JD. Recent advances in the treatment of pancreatic cancer. 2020;9:F1000 Faculty Rev-131. Prades J, Arnold D, Brunner T, et al. Bratislava Statement: consensus recommendations for improving pancreatic cancer care. ESMO Open. 2020;5(6):e001051. www.cancer.org/cancer/pancreatic-cancer/about/key-statistics.html www.pancreasfoundation.org/npf-centers-info/
