Impact of a centralised pancreaticobiliary tumour board on the diagnosis of pancreatic lesions

Background and study aims: Since 2019, pancreatic surgery in Belgium has been centralised to high-volume centres to improve care quality and reduce postoperative morbidity and mortality. All patients who are potential surgical candidates are discussed preoperatively at a centralised multidisciplinary board (MCCC = Multidisciplinair Consult Complexe Chirurgie). Typically, patients with a (possible) malignancy have already been evaluated by a multidisciplinary tumour board (MDT) in the referring hospital. This study aimed to assess the impact of the MCCC on the diagnosis of solid and cystic pancreatic lesions and to analyse referral patterns.

Patients and methods: This single-centre, non-interventional retrospective study included 217 patients with a newly diagnosed pancreatic lesion, discussed at the MCCC of Ghent University Hospital between July 1, 2019, and December 31, 2021. The influence of the MCCC on the diagnosis of pancreatic lesions was analysed.

Results: Among 217 patients (median age 65 years; 50% male), the most frequent diagnoses were pancreatic adenocarcinoma (n=99; 45,6%), IPMN (12%) and pancreatitis (7%). The MCCC altered the initial diagnostic assessment in 18,4% of cases. Among benign referrals, 20% (5/25) were ultimately found malignant, likely altering treatment. None of the 166 patients referred with a malignant diagnosis were reclassified as benign. During the first three years after centralisation, referral quality remained unchanged, with 12% unspecified lesions annually.

Summary: Centralisation may over time affect referral quality as expertise concentrates. Initial diagnosis and staging still occur in referring hospitals and are first discussed locally. This early analysis shows stable referral appropriateness after centralisation. Ongoing monitoring is needed to evaluate longterm effects of centralisation on diagnostic quality and early detection.

Keywords: centralisation, pancreatic surgery, tumour board, referral quality, diagnostic accuracy.