Synoptic Multidisciplinary Team Meeting Workflows to Promote Guideline-Based Classification of Resectability in Pancreatic Cancer: A Multicenter Prospective Study.

Abstract

To address incomplete and inconsistent classification of pancreatic cancer resectability according to International Association of Pancreatology (IAP) anatomic, biologic, and conditional criteria. We designed, implemented, and evaluated an interoperable, web-based platform that captured structured pretreatment data and performed algorithm-driven resectability classification. Linked modules supported referral to and discussion at multidisciplinary team meetings (MDTMs) at two quaternary hospitals (June 2021-February 2022) and populated downstream documentation. In a pre-post study, Pearson χ² test and multivariable logistic regression (odds ratios [ORs] with 95% CI) compared data completeness (primary end point), as well as the distribution of IAP-defined resectability and treatment intent (secondary end points). In the postintervention cohort, overall survival (OS) was stratified by IAP resectability using Kaplan-Meier curves and compared using the log-rank test. Hazard ratios (HRs) with 95% CIs and log-rank statistics were calculated for individual resectability criteria using Cox models. All tests were two-sided with nominal significance (<i>P</i> < .05). An embedded module evaluated workflow integration and user experience. Ninety-five patients with pancreatic cancer were referred to MDTMs during the intervention period, of whom 71 were eligible. Compared with 71 preintervention patients, the system improved documentation of tumor-vessel relationships (OR, 9.39 [95% CI, 4.43 to 21.7]), locoregional lymphadenopathy (OR, 30.5 [95% CI, 11.1 to 102]), and performance status (PS; OR, 3.34 [95% CI, 1.67 to 6.85]), reducing the number with <i>unknown</i> resectability (OR, 0.10 [95% CI, 0.03 to 0.25]). PS ≥ 2 (HR, 2.16 [95% CI, 1.06 to 4.43]) and serum CA19.9 ≥ 500 U/mL (HR, 1.94 [95% CI, 1.03 to 3.63]) were significantly associated with OS, whereas anatomic criteria were not. A synoptic intervention integrated into MDTM workflows across multiple sites improved structured data capture, reduced <i>unknown</i> resectability, and highlighted the relevance of biologic and conditional criteria in addition to tumor anatomy.