The Dutch pancreatic cancer audit Improving patient outcomes in pancreatic surgery

This thesis, entitled ‘The Dutch Pancreatic Cancer Audit - Improving patient outcomes in pancreatic surgery’, explores ways to optimize quality of care through national auditing, international standardization, and clinical trials.
Part I demonstrates the value of the Dutch Pancreatic Cancer Audit and identifies factors that can optimise its use to improve quality of care. It shows that composite metrics like the "Ideal Outcome" and 90-day mortality are much more reliable for comparing hospitals than traditional mortality rates. It also highlights that ten years of auditing improved outcomes mostly in high-volume centers, supporting the need for further centralization.
Part II addresses international reporting challenges and highlights the problem of high inter-observer variability when grading postoperative complications. To enhance comparability across studies, it applies the ‘Ideal Outcome’ metric to allow standardized benchmarking and introduces a practical new consensus definition for delayed gastric emptying to ensure uniform reporting.
Finally, Part III focuses on reducing postoperative complications in two clinical trials. Although FIBROPANC-Trial did not demonstrate an effect of preoperative stereotactic body radiotherapy to prevent fistulas, it highlighted the substantial burden of POPF in the high-risk population. The upcoming PANENCA trial will test a combined medical and surgical approach to better protect high-risk patients.