Observational studyThe British journal of surgery2026
Surgical outcomes from nationwide implementation of the international best practice for locally advanced pancreatic cancer (PREOPANC-4) study.
Observational study in The British journal of surgery, 2026. The graph could read no effect estimate from its abstract, so it casts no vote on the map. Not yet cited in PubMed.
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Abstract
backgroundIn expert centres, surgical resection rates for patients with locally advanced pancreatic cancer (LAPC) after induction chemotherapy have increased beyond 20% with subsequent 25% 5-year overall survival (OS). In the Netherlands, however, the historical low 8% LAPC resection rate compared with 23% in international expert centres reflects a relative reluctance to perform resections. Thereby, opportunities to achieve long-term survival in appropriately selected patients may be missed. The aim of this study was to evaluate whether nationwide implementation of international multidisciplinary best practice for LAPC management is feasible while maintaining surgical safety benchmarks (in-hospital/30-day major morbidity <50% and mortality ≤5%).
methodsA multidisciplinary protocol was designed in collaboration with four international experts and prospectively implemented nationwide within the Dutch Pancreatic Cancer Group (DPCG) (2022-2024). This observational cohort included consecutive patients diagnosed with LAPC, defined by DPCG criteria. Eligible patients had radiologically non-progressive disease after ≥4 months of multiagent chemotherapy. All patients who underwent resection were included in this safety analysis. A predefined subgroup analysis included patients with National Comprehensive Cancer Network (NCCN) LAPC. Primary outcomes included in-hospital/30-day major morbidity (that is Clavien-Dindo grade ≥IIIa) and mortality. The expected number of resections was 53.
resultsOverall, 180 patients with LAPC underwent surgical exploration, of whom 155 (86%) underwent resection in 11 centres. Most resections (74%) were performed in the three LAPC surgical centres. An extended resection was performed for 77% of patients, including portomesenteric venous (60%), multivisceral (23%), and arterial (21%) resections. The in-hospital/30-day major morbidity rate was 44% and the mortality rate was 0.6%, both within pre-established safety benchmarks. Benchmarks were also reached for patients with NCCN LAPC (49% major morbidity and 2% mortality).
conclusionNationwide implementation of the international best practice for LAPC was feasible with nearly three times more resections performed than expected, while morbidity and mortality remained well within predefined safety benchmarks.
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