Abstracts
2000 Digestive Disease Week

# 2304 Differences in Diagnostic Work-Up for Pancreatic Carcinoma Between Centres and General Hospitals.
Esther H B M Tilleman, Tiny Benraadt, Dirk J. Gouma, Amsterdam, Netherlands

The majority of research on the efficiency of diagnostic work-up and treatment of pancreatic carcinoma has been performed in high volume centers with experience. Unfortunately only the minority of patients are initially diagnosed in these hospitals. Therefore the aim of this study was to evaluate the diagnostic work-up and treatment of pancreatic carcinoma patients in general hospitals in a district of the Netherlands. Patients with pancreatic carcinoma (n=278) diagnosed and registered in the district of the Comprehensive Cancer Center Amsterdam (IKA), (2.6 million inhabitants, 17 general hospitals, 2 academic hospitals and 1 cancer center,) between January and December 1997 were included. Data concerning patient characteristics, diagnostic procedures, tumor characteristics and treatment where analyzed. 253 patients (91%) presented in a general hospital (m:116, f:137, and mean age 70 years (range 40-96)), presenting symptoms where jaundice (52%), pain (73%), weight loss (78%) and recent developed diabetes (10 %). At first presentation, the following diagnostic procedures were performed: ultrasound (97%, 4% in combination with Doppler), CT scan (56%, no spiral CT), ERCP (39%), and diagnostic laparoscopy (4%). The mean period between first symptoms and date of diagnosis was 10.4 weeks. In 34% of the patients no treatment was performed because of extensive disease, 23% were palliated with endoprosthesis (14%) and bypass operation (9%). Forty percent of the patients were referred to a center for further diagnostic work-up (ultrasound in combination with Doppler (60%), spiral CT (34%), ERCP (62%) and diagnostic laparoscopy (28%)) and further treatment. In this selected group of patients resection was only performed in 14%, others underwent palliative treatment (bypass (12%), endoprosthesis (47%), or even no treatment (27%)). Fifty-seven percent of the patients with pancreatic carcinoma have extensive disease at the time of diagnosis and are managed in the hospital of first admission with relatively simple diagnostic work-up and palliative treatment. Resection after referral could only be performed in 14%. Improvement of diagnostic workup could lead to a better selection of patients for centralization.