Surgical Outcomes from Nationwide Implementation of the International Best-Practice for Locally Advanced Pancreatic Cancer (PREOPANC-4) study

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ID: 318250
2026
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Abstract
BACKGROUND: In expert centers, surgical resection rates of locally advanced pancreatic cancer (LAPC) following induction chemotherapy have increased beyond 20% with subsequent 25% five-year overall survival (OS). In the Netherlands, however, the historical low 8% LAPC resection rate compared with 23% in international expert centers reflects relative reluctance. Thereby, opportunities to achieve long-term survival in appropriately selected patients may be missed. This study evaluated whether nationwide implementation of international multidisciplinary best-practice for LAPC management is feasible while maintaining surgical safety benchmarks (in-hospital/30-day major morbidity <50% and mortality ≤5%). METHODS: A multidisciplinary protocol was designed in collaboration with four international experts and prospectively implemented nationwide within the Dutch Pancreatic Cancer Group (DPCG) (2022-2024). This observational cohort included consecutive patients diagnosed with LAPC, defined by DPCG criteria. Eligible patients had radiologically non-progressive disease after at least four months of multi-agent chemotherapy. All patients who underwent resection were included in this safety analysis. A predefined sub-group analysis included patients with National Comprehensive Cancer Network (NCCN) LAPC. Primary outcomes included in-hospital/30-day major morbidity (i.e., Clavien-Dindo grade ≥IIIa) and mortality. The expected number of resections was 53. RESULTS: Overall, 180 patients with LAPC underwent surgical exploration, of whom 155 (86%) underwent resection in 11 centers. Most (74%) resections were performed in the three LAPC surgical centers. Extended resections were performed in 77% of patients, including portomesenteric venous (60%), multivisceral (23%), and arterial (21%) resections. In-hospital/30-day major morbidity rate was 44% and mortality rate was 0.6%, both within pre-established safety benchmarks. Benchmarks were also reached for patients with NCCN LAPC (49% major morbidity, 2% mortality). CONCLUSION: Nationwide implementation of the international best-practice for LAPC was feasible with nearly three times more resections performed than expected, while morbidity and mortality remained well within predefined safety benchmarks.
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Authors Thomas F. Stoop, Leonard W F Seelen, Freek R. van ‘t Land, Jacobien C M Scheepens, Mahsoem Ali, Anna C van der Hout, Marion van der Kolk, Bert A. Bonsing, Daan J Lips, Eric R. Manusama, François E J A Willemsen, F Daams, G Kazemier, Gijs A Patijn, Onno Kranenburg, Jan H. Wijsman, Jennifer Schreinemakers, Joris I. Erdmann, J. Sven D. Mieog, Joost M Klaase, Judith Rietjens, Koop Bosscha, Lysanne P M Beuk, Maarten W. Nijkamp, Marcel den Dulk, M Kop, Mike S L Liem, Misha Luyer, Martijn W.J. Stommel, Olivier R. Busch, S Festen, Stefan A.W. Bouwense, Tom M. Karsten, Tom W van Ravens, U Neumann, Vincent E. de Meijer, Vincent B Nieuwenhuijs, W A Draaisma, Wouter Derksen, Thomas L Bollen, Bas Groot Koerkamp, van Eijck, I Quintus Molenaar, Christopher L Wolfgang, M Del Chiaro, Matthew H. G. Katz, Thilo Hackert, Johanna W Wilmink, Hjalmar C van Santvoort, Roeland F de Wilde, Marc G. Besselink, for the Dutch Pancreatic Cancer Group, Adriënne te Riele, Aniek Vlijm, Ankie Van Der Velden, Anne Bruynzeel, Anne M. Stiggelbout, Anne-Marie Dietvorst, Annemarie Conijn-Mensink, A W Haringhuizen, Anneke Roeterdink, A Baltussen van Zweeden, Anouk van Asseldonk, Ammar A Javed, André Sterk, Annuska Schoorlemmer, Anja Stam, Aram van Brussel, Barbara M. Zonderhuis, Bas Boekestijn, Bibi Martens, Brigitte Haberkorn, C Yung Nio, Celine Leenen, Daud Allajar, Deborah Reijnders-Tromp, Dirk-Jan de Groot, Els Wink-Van Gestel, Emile D. Kerver, Eran van Veldhuisen, Eva Versteijne, Evelien van Alphen, Evert van den Broek, Geert A. Cirkel, Geertjan van Tienhoven, Geeske Heringa, Gert Stockmans, G Serafino, Hannàh N Lelieveld-Rier, H A Van Laarhoven, Hanneke Zuetenhorst, Haske van Veenendaal, Hetty van Mierlo, Ingeborg Griffioen, Ingmar F Rompen, Irene E G van Hellemond, Iryna Symarska, Jacques Peters, Jan‐Willem B. de Groot, Jeanette Ham
Journal the british journal of surgery
Year 2026
DOI
10.1093/bjs/znag075
URL
https://doi.org/10.1093/bjs/znag075
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