Impact of multidisciplinary approach and radiologic review on surgical outcome and overall survival of patients with pancreatic cancer: a retrospective cohort study

Aim: To evaluate the impact of multidisciplinary team case discussion including computed tomography (CT) radiologic review on surgical outcome and overall survival (OS) of patients with pancreatic ductal adenocarcinoma (PDAC). Methods: Patients with PDAC evaluated in 2008–2011 and 2013–2016 (before and after multidisciplinary team introduction), aged <85 years and staged I–III, were included. Surgical failures and 2-year OS were compared in these periods. Available CT scans of preintervention period (2008–2011) cases were reviewed by two radiologists in consensus, assigning a resectability judgment to evaluate in how many cases a different recommendation would be achieved. Results: A total of 316 patients (49.3% female, age 71±10 years) were included: 132 in 2008–2011 and 184 in 2013–2016. The proportion of patients who underwent upfront surgery was similar in the two periods (51% vs 47% in 2008–2011 vs 2013–2016). Neoadjuvant referral increased from 7% to 21% and surgical resection was excluded for 42% patients in 2008–2011 vs 33% in 2013–2016 (p = 0.002). Adjusting by age, sex, and stage, surgical failures slightly decreased in 2013–2016 (odds ratio 0.89, 95% confidence interval 0.53–1.51); the decrease was stronger when therapeutic choice complied with CT indications (odds ratio 0.76, 95% confidence interval 0.36–1.63); in both cases, the decrease could be due to chance. After correction for age, sex, and stage, the hazard ratio of 2013–2016 for OS was 0.83 (95% confidence interval 0.64–1.09). In 33/114 (29%) patients, CT retrospective review produced a change in resectability judgment. Conclusion: Although differences could be due to chance or generic improvement, the consistency between process and outcome indicators suggests that multidisciplinary team approach with radiologic review may improve outcomes.