Tuesday 7th July saw the Pancreatic Cancer UK Hepatobiliary and Pancreatic study day for Health Professionals take place at the University Hospitals of Birmingham Postgraduate Centre.
Mr.Keith Roberts explained to attendees what they could expect from the day and this was followed by an excellent presentation by his colleague, Professor Darius Mirza, who spoke about vein resection during pancreatic surgery. He emphasised the fact that studies have demonstrated a survival benefit for vein resection over palliative surgery. Keith Roberts then took to the stand for a second time on the prediction of pancreatic fistula following pancreatoduodenectomy. He commented that the rate across most HPB units was 20-25%, and that drain fluid amylase was the key to diagnosis.
We then had a very stimulating presentation by Mr Ravi Marudanayagam, Hepatobiliary and Pancreatic Surgeon at QEHB discussing the ESPAC 5 clinical trial in the surgical group of patients. This is an excellently designed feasibility trial, with 4 arms, comparing immediate surgery (within 2 weeks of randomisation), with neoadjuvant chemo/chemo radiotherapy. Chemotherapy regimes used will be Gemcitabine/Capecitabine or Folfirinox, and in the chemorad arm, the chemotherapy is the choice of the clinician. The outcomes of this study will be very much anticipated.
Professor Sohei Satoi, from Osaka, Japan gave us two insightful presentations about his practice in Japan. The first was about surgery after down staging chemotherapy using the drug S-1. After 6 months of initial treatment with this drug, 15 out of 509 patients went on to have surgery for their previously unresectable pancreatic cancer.
His second presentation was on S-1, which is now considered as the new standard treatment for resected pancreatic cancer patients in Japan, and it is well tolerated. It appears though, that toxicity from this drug will be greater in the Caucasian population, whereas, it is significantly less in the Japanese.
As ever, diet and the use of pancreatic enzyme replace therapy (PERT) was on our agenda. Mary Phillips gave another fantastic presentation on malnutrition in pancreatic cancer, and encouraged us to be more “aggressive” in feeding patients who are malnourished – in the inoperable setting.
Professor Harald Schrem from Hannover continued this theme presenting data from a study carried out between Hannover and Birmingham, evaluating the relationship between pancreatic enzyme replacement therapy and survival after pancreatoduodenectomy.
Our keynote lecture was from Professor Dominguez-Munoz, from Spain, who gave us a very clear and concise presentation on Pancreatic Enzyme Insufficiency (PEI). There can be no doubt after listening to him that we are not assessing these patients early enough, nor are we actually assessing all of the patients – in his opinion, all pancreatic cancer patients will suffer from PEI and will need PERT.
Our own Anna Jewell, acting Director of Operations, gave an excellent round up of the work of Pancreatic Cancer UK, and the ongoing projects which people can get involved with.
After lunch, we had a very good presentation on enhanced recovery by Mr.Rob Sutcliffe from Queen Elizabeth Hospital, Birmingham (QEHB). Dr. Yuk Ting Ma spoke on down staging chemotherapy, and spoke about this from the point of view of the “pre Folfirinox” and “post Folfirinox” era.
Dr. Shakeeb Khan spoke on the local experience of down staging chemotherapy at QEHB, and Dr.Max Almond gave an overview of total pancreatectomy over the past 25 years.
Lewis Stephens presented on survival prediction based on lymph node ratio, showing that positive lymph node involvement has a significantly negative influence on post-op survival.
Perhaps the greatest congratulations of the day should go to Margaret Datson, who spoke about her own experience of being a pancreatic cancer patient. Margaret spoke eloquently, and replayed her journey in a measured and constructive way, from her own mother’s death from pancreatic cancer in 2000, to her diagnosis in 2006. Margaret spoke highly about the care and attention she received at QEHB. A poignant moment occurred at the end of Margaret’s talk, when she went to greet her surgeon on the front row, Professor Darius Mirza, and they exchanged a hug. This more or less epitomised the theme of the day at Birmingham, a theme of gratitude all around.
All in all, a great day was had at Birmingham, and we were delighted with the attendance. It was great to forge links with folk in QEHB, one of the largest specialist centres in the UK, and to see the day evolve after so much hard work from all involved. A massive thanks to all.