@article{91ff23e56f50400cbebb39dec96fedb2,
title = "Implementation of a strategic preoperative surgical meeting to improve the level of care at a high-volume pancreatic center: a before–after analysis of 1000 consecutive cases",
abstract = "The indication, planning, and risk analysis of a pancreatic surgical procedure have recently become increasingly complex. In December 2015, the “Pancreas Round” (PR) meeting was established at our institution to preoperatively review all scheduled cases with a specific focus on surgical indications and technical issues. The present study aims to determine the impact of the PR on the clinical practice in terms of avoiding unrequested laparotomies and anticipating intraoperative pitfalls. A “before–after” study was conducted by retrospectively comparing a pre-intervention period (9/2014–11/2015) to a prospectively assessed post-intervention one (12/2015–3/2017). Outcomes considered were explorative laparotomy (EL) occurrence and a “mismatch” between what was preoperatively expected by the PR and what was intraoperatively found. Of the 1057 patients included in the present study, 531 underwent surgery in the pre- and 526 in the post-intervention period, respectively. The EL rate was comparable between the two periods (15.4% vs. 12.2%, p = 0.123), despite the significant increase of surgical explorations after neoadjuvant chemotherapy during the post-intervention period (27% vs. 18%, p < 0.001). The “mismatch” rate between preoperative planning and intraoperative findings was significantly reduced in the post-intervention period (12.2% vs. 8.4%, p = 0.038) compared to the pre-PR period. In the setting of a high-volume center, a preoperative surgical meeting designed to review all cases scheduled for surgical exploration can enhance the level of care by addressing intraoperative pitfalls.",
keywords = "Before–after study, Pancreatic surgery, Preoperative planning, Surgical team meeting",
author = "{SPaRo Group} and Niccol{\`o} Surci and Marco Ramera and Alex Borin and Giovanni Marchegiani and Roberto Salvia and Claudio Bassi and R. Salvia and L. Casetti and A. Esposito and M. Fontana and L. Landoni and G. Malleo and S. Paiella and A. Pea and M. Tuveri and M. De Pastena and H. Impellizzeri and L. Maggino and R. Piccolo and V. Todaro and F. Accordini and V. Allegrini and S. Andrianello and A. Bunicci and I. Damoli and E. Marrano and M. Miotto and A. Pulvirenti and A. Borin and {Dal Borgo}, C. and G. Perri and E. Viviani and Zingaretti, {C. C.} and E. Bannone and A. Balduzzi and D. Ciprani and L. Crepaz and T. Giuliani and G. Masini and C. Nessi and N. Surci and L. Bertoldi and C. Bortolato and F. Casciani and A. Di Gioia and S. Nobile and E. Sereni and M. Adham and H. Friess and Wolfgang, {C. L.}",
note = "Funding Information: SPaRo Group (Surgical Pancreas Round Group) members: Prof. C. Bassi, Prof R. Salvia, L. Casetti MD, A. Esposito MD, M. Fontana MD, L. Landoni MD, G. Malleo MD, G. Marchegiani MD, S. Paiella MD, A. Pea MD, M. Tuveri MD, M. De Pastena MD, H. Impellizzeri MD, L. Maggino MD, R. Piccolo MD, V. Todaro MD, F. Accordini MD, V. Allegrini MD, S. Andrianello MD, A. Bunicci MD, I. Damoli MD, E. Marrano MD, M. Miotto MD, A. Pulvirenti MD, M. Ramera MD, A. Borin MD, C. Dal Borgo MD, G. Perri MD, E.Viviani MD, C.C. Zingaretti MD, E. Bannone MD, A. Balduzzi MD, D. Ciprani MD, L. Crepaz MD, T. Giuliani MD, G. Masini MD, C. Nessi MD, N. Surci MD, L. Bertoldi MD, C. Bortolato MD, F. Casciani MD, A. Di Gioia MD, S. Nobile MD, E. Sereni MD. Special guests of the Meeting as “visiting Professor” during the present study period: Prof. M. Adham (University of Lyon), Prof. H. Friess (University of Munich), Prof. J.P. Neoptolemos (University of Heidelberg), Prof. C.L. Wolfgang (Johns Hopkins University School of Medicine-Baltimore). Publisher Copyright: {\textcopyright} 2020, Italian Society of Surgery (SIC).",
year = "2020",
month = mar,
day = "1",
doi = "10.1007/s13304-020-00707-8",
language = "English (US)",
volume = "72",
pages = "155--161",
journal = "Updates in Surgery",
issn = "2038-131X",
publisher = "Springer-Verlag Italia",
number = "1",
}