SOUTHWEST PROGRAM FOR PANCREATIC CANCER

CLINICAL BACKGROUND

The establishment of the OU ~ Southwest Program for Pancreatic Cancer has as its impetus the pancreatic cancer patients whose treatment is managed by a team effort involving the Departments of Surgery, Medicine, and Radiological Sciences.

The pancreas surgeons involved in the OU Surgical Oncology Group are Russell G. Postier, MD, John A. Schilling Professor and Chairman of the Department of Surgery; Larry Pennington, G. Rainey Williams Professor; Chief, Transplant Section; Vice-Chair, Department of Surgery; and Jeffrey Bender, MD, Professor, Chief of Laproscopic Surgery.

The oncology group is led by Mehrdad Jafari, MD; Professor Asst., Section of Hematology – Oncology, Director of the OU Cancer Center, Department of Medicine.

Radiation therapy is led by Terrance Herman, MD; Professor and Chairman, Radiation Therapy; Department of Radiation Sciences.

William Tierney, MD, Assistant Professor; Section of Gastroenterology; Director, Endoscopic Ultrasound; Department of Medicine leads the diagnostic component of the team.

The most effective treatment for pancreatic cancer is a surgical operation known as pancreaticoduodenectomy (sometimes referred to as the Whipple procedure, http://pathology2.jhu.edu/pancreas/surgery.cfm ) combined with the appropriate chemo and radiation therapy strategies. Recent reports from several leading institutions in the United States document that an inverse relationship exists between mortality rates associated with the Whipple procedure and hospital pancreatic cancer patient volume, as well as hospital teaching status.

In four academic years from April of 1998 to June of 2002 approximately 250 pancreatic surgical procedures have been performed at our institution by the OU Surgical Oncology pancreatic cancer team.

Of these 250, approximately 200 involved pancreatic tumors and cancer; well over 100 of these
patients were cared for in the last two years of this four year period.

In the first half of the 2002 – 2003 academic year thirty–two pancreatic surgical procedures have already, been performed at our institution; 26 of these 32 have been the Whipple procedure for pancreatic cancer.

The “Report of the Pancreatic Cancer Progress Review Group” to the National Cancer Institute has proposed that centers of excellence for pancreatic cancer care and research may be desirable due to data demonstrating that institutions performing higher numbers of pancreaticoduodenectomy provide an improved level of care with superior outcomes. This report suggested 25 or greater per year as the criteria for recognition as a center. Currently, only one-third of pancreatic cancer patients are referred to institutions treating more than 25 pancreatic cancer patients per year or performing 25 pancreatic resections per year.

The “National Cancer Policy Board” has recommended selective referral to high-volume centers for pancreaticoduodenectomy procedures due to convincing outcome data over the last several years.

This same evidence has prompted “The Center for Medicare and Medicaid” to consider the inclusion of procedure volumes for hospitals in the United States on its internet web page.

Additionally, the “Leapfrog Group”, which is a large coalition representing over 30 million public and private patients is emphasizing minimum volume standards for selected procedures including pancreaticoduodenectomy.

Surgical procedure volumes for individual hospitals are currently becoming “available on the internet” which will contribute to the education of the pancreatic cancer community and aid in the selection of the most appropriate health care providers for pancreatic cancer patients.

The importance of experience in the care of pancreatic cancer patients has recently been confirmed in a report and emphasized in an editorial comment in the “Annals of Surgical Oncology”.

The criteria for Centers of Excellence established by these reports has existed and has been substantially exceeded at the University of Oklahoma Health Sciences Center for over four years and importantly, has already been exceeded in the first half of the current academic year. The focus on pancreatic cancer at the OU Health Sciences Center sets the regional standard for care of pancreatic cancer patients. The experience attained under the leadership and direction of the OU Surgical Oncologists in caring for the high volume of pancreatic cancer patients at the OU Health Sciences Center has resulted in significant reductions in operating time, complication rate, and mortality rate. The OU ~ Southwest Program for Pancreatic Cancer assures state-of-the-art health care for pancreatic cancer patients in Oklahoma and the surrounding Southwest Region without the necessity of excessive travel and expense for the patient, as well as family and friends.

REFERENCES

Raising the Bar for Pancreaticoduodenectomy (Editorial). JD Birkmeyer; Annals of Surgical Oncology, v 9: 826 – 827, 2002. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&

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National Estimates of Mortality Rates for Radical Pancreaticoduodenectomy in 25,000 Patients. CA Kotwall, JG Maxwell, CC Brinker, GG Koch, DL Covington; Annals of Surgical Oncology, v 9: 847 – 854, 2002.

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids

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Hospital Volume and Surgical Mortality in the United States. JD Birkmeyer, AE Siewers, EVA Finlayson, et al; New England Journal of Medicine, v 346: 1128 – 1137, 2002.

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Volume Standards for High Risk Surgical Procedures: Potential Benefits of the Leapfrog Initiative. JD Birkmeyer, EV Finlayson, CM Birkmeyer; Surgery, v 130: 429 – 431, 2001

http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=

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National Cancer Policy Board: Interpreting the Volume – Outcome Relationship in the Context of Cancer Care. M Hewitt, D Petitti; Washington DC, National Academy Press, 2001.

Impact of Hospital Volume on Operative Mortality for Major Cancer Surgery. CB Begg, LD Cramer, WJ Hoskins, MF Brennan; Journal of the American Medical Association, v 280: 1747 –1751, 1998. http://www.ncbi.nlm.nih.gov/entrez/query.fcgi?cmd=Retrieve&db=PubMed&list_uids=

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