The impact of a multidisciplinary team approach on the management of focal pancreatic lesions: a single tertiary center experience

Sophie Francisse; Paraskevas Gkolfakis; Michael Fernandez Y. Viesca; Laura Mans; Anne Demols; Martina Pezzullo; Patricia Loi; Julie Navez; Jean Closset; Maria Antonietta Bali; Morgane Van Wettere; Nicki D’Haene; Pieter Demetter; Laurine Verset; Christelle Bouchart; Arnaud Lemmers; Jacques Deviere; Myriam Delhaye; Jean-Luc Van Laethem; Marianna Arvanitakis

Authors Sophie Francisse, Paraskevas Gkolfakis, Michael Fernandez Y. Viesca, Laura Mans, Anne Demols, Martina Pezzullo, Patricia Loi, Julie Navez, Jean Closset, Maria Antonietta Bali, Morgane Van Wettere, Nicki D’Haene, Pieter Demetter, Laurine Verset, Christelle Bouchart, Arnaud Lemmers, Jacques Deviere, Myriam Delhaye, Jean-Luc Van Laethem, Marianna Arvanitakis.

Abstract

Background Multidisciplinary team (MDT) meetings aim to optimize patient management. We evaluated the impact of MDT discussions on the management and diagnosis of focal pancreatic lesions in a single tertiary center.

Methods All patients with an initial diagnosis of solid or cystic pancreatic lesion discussed in our institution’s MDT meeting on pancreatic diseases between January 1, 2020, and December 31, 2021, were included. The impact of MDT discussion on patient management, defined as a modification of the initially proposed therapeutic plan after MDT discussion, as well as the criteria leading to this modification, were the primary outcomes. Impact on diagnosis was the secondary outcome.

Results A total of 522 patients were included. Of these, 185 (35.4%) and 337 (64.6%) had an initial diagnosis of cystic or solid lesion, respectively. The most common referral query was regarding the management plan (349/522; 66.9%). Endoscopy was the procedure most often proposed before MDT discussion (109/522; 20.9%). Overall, the MDT discussion led to modification of the management plan in 377/522 patients (72.2%), with a statistically significant difference between cystic and solid lesions (63.2% vs. 77.2%; P<0.001). Management modifications were mainly driven by revision of cross-sectional radiological images. MDT discussion led to modification of the diagnosis in 92/522 patients (17.6%), with a significant difference regarding cystic lesions (35.7% vs. 7.7%; P<0.001).

Conclusion MDT discussion impacts the management of patients with cystic and solid pancreatic lesions, leading to a modification of the initially proposed management in two-thirds of them, mainly through revision of cross-sectional imaging.

Keywords Multidisciplinary team, pancreatic cancer, cystic lesions, solid lesions

Ann Gastroenterol 2023; 36 (5): 580-587