What would you do? A survey of HPB surgeons practice patterns

Area of Science:

• Surgical Oncology
• Gastrointestinal Surgery
• Clinical Practice Variation

Background:

• Pancreatic ductal adenocarcinoma (PDAC) surgery presents complex decision-making challenges.
• Existing practice guidelines inadequately address many common intraoperative scenarios.
• Variations in surgical practice patterns for PDAC require investigation.

Purpose of the Study:

• To identify and analyze practice pattern variations among pancreatic surgeons.
• To understand surgeon responses to common clinical scenarios encountered during PDAC surgery.

Main Methods:

• A multiple-choice questionnaire survey was distributed to International HPB Association (IHPBA) members.
• Participants provided demographic, training, and clinical practice details.
• Responses to various operative scenarios were collected and analyzed anonymously.

Main Results:

• 164 surgeons responded; most were male with >10 years of experience.
• Selective use of staging laparoscopy was common; aorto-caval node positivity led to abortion, unlike hepatic artery node positivity.
• Resection was favored for Segment 2 liver metastasis (Europe vs. Asia/North America) and direct colonic invasion; fewer PDAC operations/year correlated with higher abortion rates.

Conclusions:

• Significant disagreement exists regarding the optimal management of PDAC surgical scenarios.
• The survey underscores the need for developing consensus guidelines for frequently encountered operative situations.
• Standardizing decision-making in PDAC surgery is crucial for improving patient outcomes.