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CREATING THE BUILDING BLOCKS FOR THE FIRST PANCREAS REFERRAL CENTER IN GREECE: HARDSHIPS AND SUCCESSES.
Aikaterini Dedeilia
*1, Grigorios Tsiotos
2, Nikiforos Ballian
2, Fotios Milas
3, Charitini Salla
3, Ilias Athanasiadis
3, Flora Stavridi
31Surgery, Massachusetts General Hospital, Boston, MA; 2Mitera-Hygeia Hospital, Department of Surgery, Marousi, Greece; 3Mitera-Hygeia Hospital, Marousi, Greece
Introduction: In the context of significant healthcare limitations imposed by a decade-long financial crisis and a public-only university-based strong hierarchical structure in medicine in Greece, four American board-certified physicians, associated with highly motivated colleagues, each with significant pancreas-dedicated background, have focused on state-of-the-art service to patients with pancreas disease and pancreatic cancer specifically. We report on our increasing collective experience in our evolving first national pancreas referral center.
Methods: Retrospective analysis of prospectively collected data on patients with pancreatic disease who received consultation, diagnostic or staging procedures, chemotherapy, radiation therapy, or surgery in our tertiary referral center between January 2019 and December 2022.
Results: A total of 722 patients (adenocarcinoma - PDAC: 525, intraductal papillary mucinous neoplasm - IPMN: 79, neuroendocrine tumor - NET : 34, other: 84) were seen in our clinic. Endoscopic ultrasound was performed in 339 patients, pancreas cytology in 1024 (37% referred for a second opinion), 211 new patients received chemotherapy, and 21 neoadjuvant radiation therapy. A total of 122 pancreas resections were performed (PDAC: 82, IPMN:7, NET:12, other:21). Among patients with PDAC, 76 (93%) underwent R0 (≥1mm) resection and 32 (39%) had borderline/locally advanced disease. Of those, 21 (66%) required portal vein resection, 7 (22%) major arterial resection, and 8 (25%) major arterial divestment. Median ICU and hospital stay were 0 and 7 days respectively. Median number of blood units transfused was 0. Postoperative morbidity was 27% (n=22), and postoperative mortality was 4.9% (n=6). Four papers on major vascular resections for locally advanced PDAC were published in peer-reviewed English language journals, each one of them being the first in its topic from Greece.
Conclusion: Despite hardships, the commitment of an objectively and highly qualified group of physicians can collectively and synergistically increase the volume and improve the quality of pancreas disease management, creating the essentials for a national pancreas referral center.
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