Early Perioperative Fluid Benchmarking to Predict Pancreaticoduodenectomy (PD) Outcomes

Introduction: PD is a complex operation associated with a marked systemic inflammatory response and significant fluid shifts. Establishing a benchmark for ideal perioperative fluid management is critical to optimising PD patient recovery. Methods: In this retrospective study, we evaluated perioperative fluid data for patients undergoing PD. We compared an optimal benchmark group who were discharged home by postoperative day five (≤5day) to a group of patients with an in hospital recovery greater than ten days (≥10day). Results: Seventy-six patients who underwent PD between June 2015 and November 2016 were evaluated. The ≤5day group had a significantly lower intraoperative fluid administration (5.4 vs. 6.6 L, p= 0.012), despite similar operative times (447 mins and 476 mins, respectively). POD1 cumulative fluid balance was lower in the ≤5day group compared to the ≥10day group, 7.8L (97 mL/kg) vs. 9.7L (148 mL/kg) (p= 0.002), respectively. As expected, the postoperative complication rate was reduced in the ≤5day group (5% vs. 95%). Complications included pancreatic fistula (40%), delayed gastric emptying (53%), and intra-abdominal infection (16%). The median weight change from baseline to POD5 was -0.2 Kg for the ≤5day group compared to +2.9 Kg for ≥10day group (p= 0.000006). Conclusions: Patients in the benchmark PD group received less fluid intraoperatively, had a lower cumulative fluid balance by POD1, and were able to return to their preoperative weight by POD5 when compared to ≥10day group. These data offer insights into optimal fluid administration for PD patients

The Role of the Uncinate Margin in Pancreaticoduodenectomy for Pancreatic Ductal Adenocarcinoma: A Survival Analysis

Introduction: Positive margins during pancreaticoduodenectomy for pancreatic cancer portend worse survival, but additional resection of the uncinate margin is typically unfeasible without major vascular reconstruction. The survival benefit of resecting additional neck or bile duct margins in the face of a positive uncinate is also unknown. We examined the impact of re-resection of these margins on survival. Methods: Patients with pancreatic adenocarcinoma who underwent pancreaticoduodenectomy from 2006-2015. Pancreatic neck, bile duct, uncinate, and duodenal frozen section margins were assessed before and after resection of positive margins. Kaplan-Meier survival curves were compared with log-rank tests. Multivariable Cox regression was used to assess the effect of margin status on overall survival. Results: Among 508 patients identified, 388 (76.4%) underwent a pylorus-preserving procedure, 435 (85.6%) had T3 tumors, and 379 (74.6%) had nodal involvement. There were 21 instances where an uncinate margin was concurrently positive with a neck or bile duct margin; this additional neck or bile duct margin was resected in 13 cases (61.9%). Resection of additional margins when the uncinate was concurrently positive was not associated with improved survival (p=0.36). Median survival with and without positive uncinate margins was 13.8 vs. 19.7 months (p=0.04). A positive uncinate margin was associated with decreased survival independent of other margins and cancer stage (HR 1.28 [95% CI 1.00-1.65]). Conclusion: In patients with pancreatic adenocarcinoma, positive uncinate margins are associated with decreased overall survival; resection of additional margins at the neck and bile duct in those with a positive uncinate margin is not warranted

16th Annual Pancreatic Cancer and Related Diseases Patient Symposium

On November 13, 2021, Charles J. Yeo, MD, FACS, and the multidisciplinary team of clinicians and scientists hosted the 16th Annual Pancreatic Cancer & Related Diseases Symposium. The video of the event is available here: vimeo.com/646517712/36786afe68. View our Pancreatic Cancer Program 2021 Update to learn more about Dr. Yeo and the team’s great work! PROGRAM Welcome and Program OverviewCharles J. Yeo, MD, FACSSamuel D. Gross Professor and Chair of Surgery Advances in FT in Treating Pancreatic CancerAdam Mueller, MD, PhDInstructor, Radiation Oncology KRAS Mutation Allele Frequency Impacts Prognosis in Pancreatic Ductal Adenocarcinoma Using Next-Generation SequencingHarish Lavu, MD, FACSProfessor of Surgery COVID-19 Pandemic and the JPTR: Results of the 2022-2021 Annual SurveyTheresa P. Yeo, PhD, AOCHP, ACNP-BC, FAANPProfessor, Jefferson College of Nursing Jefferson Pancreatic Cancer Research Institute UpdateAvinoam Nevler, MDAssistant Professor Pancreatic Cancer: Progress in Systemic TherapiesDaniel Lin, MD, MScAssistant Professor of Medical Oncology Pancreatic Neuroendocrine Tumors (PNETs): Overview and TreatmentWilbur B. Bowne, MDProfessor of Biochemistry and Molecular Biology Questions & Answers Survivor Tribute Photo & Survivor Testimonia

The Financial Implications of Pancreatic Surgery: The Hospital Is the Big Winner, Not the Surgeon!

Background:. High-volume pancreatic surgery centers require a significant investment in expertise, time, and resources to achieve optimal patient outcomes. A detailed understanding of the economics of major pancreatic surgery is limited among many clinicians and hospital administrators. A greater consideration of these financial aspects may in fact have implications for enhancing clinical care and for a broader sustainability of high-volume pancreatic surgery programs. Methods:. In this retrospective observational study, patients who underwent pancreaticoduodenectomy (PD), total pancreatectomy, or distal pancreatectomy at one academic medical center during the fiscal year 2021 were evaluated. Detailed hospital charges and professional fees were obtained for patients using the Qlik perioperative database. Clinical data for the study cohort were gathered from a prospectively maintained, IRB-approved pancreatic surgery database. Charges for the 91-day perioperative period were included. A P < 0.05 was considered significant. Results:. During the study period, 159 evaluable patients underwent 1 of 3 designated pancreatic resections included in the analysis. Ninety-seven patients (61%) were diagnosed with adenocarcinoma and 70% (n = 110) underwent PD. The total charges (combined professional and hospital charges) for the cohort encompassing the entire perioperative period were $20,661,759. The median charge per patient was$130,306 (interquartile range [IQR], $34,534). The median direct cost of care was$23,219 (IQR, $6321) and the median contribution margin per case was$10,092 (IQR, $22,949). The median surgeon professional fee charges were$7700 per patient (IQR, $1296) as compared to$3453 (IQR, $1,144) for professional fee receipts (45$4945 charges vs $1406 receipts [28$3035 charges vs $680 receipts [22%]). The surgeon professional fees were only 6% of the total charges, while the professional fees for anesthesiology and pathology were 4% and 2% of the total charges, respectively. Supply charges were 3% of the total charges. Longer operative time was correlated with increased hospital and anesthesia charges, without a significant increase in surgeon charges (P < 0.001, P < 0.001, and P = 0.2, respectively). Male sex, diabetes, and low serum albumin correlated with greater total hospital charges (P = 0.01, P = 0.01, and P = 0.03, respectively). Conclusions:. The role of the surgeon in the perioperative clinical care of major pancreatic resection patients is crucial and important and is by no means limited to the operative day. Nevertheless, in the context of the current US health care system, the reimbursement to the surgeon in the form of professional fees is a relatively small fraction of the total health care receipts for these patients. This imbalance necessitates a substantial financial partnership between hospitals and their pancreatic surgery units to ensure the long-term viability of these programs

15th Annual Pancreatic Cancer and Related Diseases Patient Symposium

On Saturday, November 14, 2020, patients/survivors and their friends and family logged in from 167 different locations to join our multi-disciplinary team for our 15th Annual (1st Virtual!) Symposium. The group discussed the latest in medical therapies, surgical options, and innovative research for pancreatic cancer. PROGRAM Welcome and Program Overview Charles J. Yeo, MD, FACS Samuel D. Gross Professor and Chair of Surgery Report of the 2019-2020 Annual Jefferson Pancreas Tumor Registry Survey Theresa P. Yeo, PhD, MPH, MSN, AOCNP Adjunct Associate Professor and Co-Director Jefferson Pancreas Tumor Registry Clinical Trials in Pancreatic Cancer Harish Lavu, MD, FACS Professor of Surgery Section Chief, Hepatopancreatobiliary Surgery Co-Director, Jefferson Pancreas Tumor Registry Recent Data on Adjuvant and Neoadjuvant Chemotherapy in Pancreatic Adenocarcinoma Atrayee Basu Mallick, MD Clinical Assistant Professor of Medical Oncology Moving Research Forward: Promising Work Amid COVID-19 Aditi Jain, PhD Research Instructor Questions & Answers W. Kim Foster Pancreatic Cancer Pilot Grant Recognition Survivor Tribute Photo & Survivor Testimonia

18th Annual Pancreatic Cancer and Related Diseases Patient Symposium

On November 11, 2023, Charles J. Yeo, MD, FACS, and the multidisciplinary team of clinicians and scientists hosted the 18th Annual Pancreatic Cancer & Related Diseases Patient Symposium. View the Event Photo Gallery View our Pancreatic Cancer Program 2023 Update to learn more about Dr. Yeo and the team’s great work! PROGRAM Welcome and Program OverviewCharles J. Yeo, MD, FACSSamuel D. Gross Professor and Chair of Surgery, Co-Director, Jefferson Pancreas, Biliary, and Related Cancer Center The Jefferson Pancreas Tumor Registry: 2022-2023 Annual UpdateEika Barriera-Justiniano, CRNPDepartment of Surgery Nicole Pocetti, CRNPDepartment of Surgery Patient Support and Programming at SKCCGreg Garber, MSW, LCSWAdministrative Director, Division of Supportive Oncology, Sidney Kimmel Cancer Center Katie Lundy, MSW, LSWOncology Social Worker, Division of Supportive Oncology, Jefferson Health-Asplundh Cancer Pavilion Targeting BARD1 in Pancreatic Cancer: “Expanding BRCAness”Aditi Jain, PhDResearch Assistant Professor, Department of Surgery Advanced Endoscopy: Leaping ForwardDavid Kastenberg, MDJ. Edward Berk Professor of Medicine and Chief, Division of Gastroenterology and Hepatology Clinical Trials Update: Antibiotics in Pancreatic SurgeryHarish Lavu, MD, FACSProfessor of Surgery and Section Chief, Hepatopancreatobiliary Surgery and Director, Jefferson Pancreas Tumor Registry What About My Gut...?James A. Posey, III, MDProfessor of Medicine and Director, Gastrointestinal Program of Medical Oncology and Co-Director, Jefferson Pancreas, Biliary, and Related Cancer Center A Patient’s StoryShawn Johnson Survivor Tribute Phot

17th Annual Pancreatic Cancer and Related Diseases Patient Symposium

On November 12, 2022, Charles J. Yeo, MD, FACS, and the multidisciplinary team of clinicians and scientists hosted the 17th Annual Pancreatic Cancer & Related Diseases Symposium. View our Pancreatic Cancer Program 2022 Update to learn more about Dr. Yeo and the team’s great work! PROGRAM Welcome and Program OverviewCharles J. Yeo, MD, FACSSamuel D. Gross Professor and Chair of Surgery SKCC Director’s Overview Andrew Chapman, DO, FACPExecutive Vice President of Oncology Services, Enterprise Director and Chief of the Sidney Kimmel Cancer Center, Professor of Medical Oncology and Co-Director, Jefferson Senior Adult Oncology Center The Jefferson Pancreas Tumor Registry: 2021-2022 Annual Update and Long-term Complications Reported by Registrants Theresa P. Yeo, PhD, MPH, AOCNP, ACNP-BC, FAANPProfessor and Co-Director, Jefferson Pancreas Tumor Registry Angiotensin Blockage in Pancreatic Cancer: A Population StudyHarish Lavu, MD, FACS Professor of Surgery and Section Chief of Hepatopancreatobiliary Surgery and Co-Director, Jefferson Pancreas Tumor Registry Stress Granules Answer a Pancreatic Cancer Mystery Elda Grabocka, PhD Assistant Professor of Research, Departments of Pharmacology, Physiology and Cancer Biology & Surgery Therapeutic Landscape in Management of Pancreatic Ductal Adenocarcinoma (PDAC) – Medical Oncology Perspective Babar Bashir, MD, MS, FACP Assistant Professor of Medical Oncology JMP PaC: Molecular Profiling of Pancreatic Cancer at SKCC and Beyond Jennifer Johnson, MD, PhDAssociate Professor of Medical Oncology and Co-Director, SKCC Precision Medicine Initiative Christopher McNair, PhD Assistant Professor of Medical Oncology and Co-Director, SKCC Precision Medicine Initiative Hien Dang, PhDAssistant Professor and Vice Chair of Research, Department of Surgery Survivor TestimonialDonna Adelsberg Survivor Tribute Phot