Evaluation and improvement of nationwide practice in pancreatic and periampullary cancer

This thesis sheds light on several topics within pancreatic and periampullary cancer and outcomes after pancreatic surgery. In 2013, the Dutch Pancreatic Cancer Project (PACAP) was launched, which comprises several registries and patient reported outcomes measures. Based on these data, part I demonstrates that practice variation was present. The PACAP-1 trial aimed to decrease this variation and improve care by enhanced implementation of best practices, regarding chemotherapy, biliary stenting, and exocrine insufficiency. The results of this trial are awaited in July 2021. Part II enhances quality of life and clinical outcomes after pancreatic surgery. For total pancreatectomy, short-term postoperative outcomes are still relatively concerning and require further research, but might be improved by increased centralization. Long-term consequences will improve due to new treatment modalities for endocrine insufficiency and more attention and guidance for pancreatic enzyme supplementation. Part III focuses on survival and predictors for survival in patients with pancreatic and periampullary cancer. A nomogram which predicts personalized conditional survival probabilities based on patient and tumor characteristics with the possibility to adjust for the period already survived after resection was developed. It is also demonstrated that overall happiness, a quality of life summary score, and several functioning and symptom scale item scores were predictive of survival. The collaboration within the Dutch Pancreatic Cancer Group (DPCG) and further development of the PACAP will be cornerstones to reach future improvements in daily clinical practice and to decrease current practice variation to ultimately increase life expectancy of pancreatic cancer patients.