Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

J Kirkegård*, E K Aahlin, M Al-Saiddi, S O Bratlie, M Coolsen, R J de Haas, M den Dulk, C Fristrup, E M Harrison, M B Mortensen, M W Nijkamp, J Persson, J A Søreide, S J Wigmore, T Wik, F V Mortensen

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Resumé

BACKGROUND: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed.

METHODS: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals.

RESULTS: A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.

CONCLUSION: Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.

OriginalsprogEngelsk
TidsskriftThe British journal of surgery
Vol/bind106
Udgave nummer6
Sider (fra-til)756-764
ISSN0007-1323
DOI
StatusUdgivet - maj 2019

Fingeraftryk

Pancreatic Neoplasms
Multicenter Studies
Neoplasm Staging
Confidence Intervals
Neoplasms

Citer dette

Kirkegård, J., Aahlin, E. K., Al-Saiddi, M., Bratlie, S. O., Coolsen, M., de Haas, R. J., ... Mortensen, F. V. (2019). Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. The British journal of surgery, 106(6), 756-764. https://doi.org/10.1002/bjs.11093
Kirkegård, J ; Aahlin, E K ; Al-Saiddi, M ; Bratlie, S O ; Coolsen, M ; de Haas, R J ; den Dulk, M ; Fristrup, C ; Harrison, E M ; Mortensen, M B ; Nijkamp, M W ; Persson, J ; Søreide, J A ; Wigmore, S J ; Wik, T ; Mortensen, F V. / Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. I: The British journal of surgery. 2019 ; Bind 106, Nr. 6. s. 756-764.
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title = "Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation",
abstract = "BACKGROUND: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed.METHODS: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals.RESULTS: A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.CONCLUSION: Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.",
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Kirkegård, J, Aahlin, EK, Al-Saiddi, M, Bratlie, SO, Coolsen, M, de Haas, RJ, den Dulk, M, Fristrup, C, Harrison, EM, Mortensen, MB, Nijkamp, MW, Persson, J, Søreide, JA, Wigmore, SJ, Wik, T & Mortensen, FV 2019, 'Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation', The British journal of surgery, bind 106, nr. 6, s. 756-764. https://doi.org/10.1002/bjs.11093

Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation. / Kirkegård, J; Aahlin, E K; Al-Saiddi, M; Bratlie, S O; Coolsen, M; de Haas, R J; den Dulk, M; Fristrup, C; Harrison, E M; Mortensen, M B; Nijkamp, M W; Persson, J; Søreide, J A; Wigmore, S J; Wik, T; Mortensen, F V.

I: The British journal of surgery, Bind 106, Nr. 6, 05.2019, s. 756-764.

Publikation: Bidrag til tidsskriftTidsskriftartikelForskningpeer review

TY - JOUR

T1 - Multicentre study of multidisciplinary team assessment of pancreatic cancer resectability and treatment allocation

AU - Kirkegård, J

AU - Aahlin, E K

AU - Al-Saiddi, M

AU - Bratlie, S O

AU - Coolsen, M

AU - de Haas, R J

AU - den Dulk, M

AU - Fristrup, C

AU - Harrison, E M

AU - Mortensen, M B

AU - Nijkamp, M W

AU - Persson, J

AU - Søreide, J A

AU - Wigmore, S J

AU - Wik, T

AU - Mortensen, F V

N1 - © 2019 BJS Society Ltd Published by John Wiley & Sons Ltd.

PY - 2019/5

Y1 - 2019/5

N2 - BACKGROUND: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed.METHODS: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals.RESULTS: A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.CONCLUSION: Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.

AB - BACKGROUND: Multidisciplinary team (MDT) meetings have been adopted widely to ensure optimal treatment for patients with cancer. Agreements in tumour staging, resectability assessments and treatment allocation between different MDTs were assessed.METHODS: Of all patients referred to one hospital, 19 patients considered to have non-metastatic pancreatic cancer for evaluation were selected randomly for a multicentre study of MDT decisions in seven units across Northern Europe. Anonymized clinical information and radiological images were disseminated to the MDTs. All patients were reviewed by the MDTs for radiological T, N and M category, resectability assessment and treatment allocation. Each MDT was blinded to the decisions of other teams. Agreements were expressed as raw percentages and Krippendorff's α values, both with 95 per cent confidence intervals.RESULTS: A total of 132 evaluations in 19 patients were carried out by the seven MDTs (1 evaluation was excluded owing to technical problems). The level of agreement for T, N and M categories ranged from moderate to near perfect (46·8, 61·1 and 82·8 per cent respectively), but there was substantial variation in assessment of resectability; seven patients were considered to be resectable by one MDT but unresectable by another. The MDTs all agreed on either a curative or palliative strategy in less than half of the patients (9 of 19). Only fair agreement in treatment allocation was observed (Krippendorff's α 0·31, 95 per cent c.i. 0·16 to 0·45). There was a high level of agreement in treatment allocation where resectability assessments were concordant.CONCLUSION: Considerable disparities in MDT evaluations of patients with pancreatic cancer exist, including substantial variation in resectability assessments.

U2 - 10.1002/bjs.11093

DO - 10.1002/bjs.11093

M3 - Journal article

VL - 106

SP - 756

EP - 764

JO - British Journal of Surgery

JF - British Journal of Surgery

SN - 0007-1323

IS - 6

ER -