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Fast track surgery to minimise the need for biliary stenting amongst patients undergoing pancreaticoduodenectomy

Recipient: Mr Keith Roberts

Host Institution: University Hospitals Birmingham NHS Foundation Trust

Title: Fast track surgery to minimise the need for biliary stenting amongst patients undergoing pancreaticoduodenectomy

Type of award: 2015 Clinical Pioneer Award

Funding: £50,000

Most patients who need to undergo surgery for pancreatic cancer have jaundice. Delays to surgery result in most patients needing treatment of jaundice which involves placement of a stent within the bile duct. However there is clear evidence from high quality trials that this procedure is potentially harmful. Patients are at risk of infections and pancreatitis; furthermore the procedure itself is unpleasant and consumes valuable healthcare resources. For these reasons it is desirable to perform early surgery without stenting where possible. This has been tried before but it is not routine within the NHS. The reasons why surgery is not performed more often without stenting are complex and unclear but likely relate to competing interests for the same service within hospitals, other logistic problems and behavioural patterns based upon existing practice. This pathway can take between two to three months from presentation at local hospital to surgery. Early diagnosis and proceeding to surgery quickly could significant reduce the time to surgery.

This study aims to review pathways patients take to surgery within the NHS and to understand the challenges to performing early surgery to avoid biliary stenting. The pancreatic surgery team at University Hospitals Birmingham are one of the largest centres for complex pancreatic surgery in Europe.

We have developed a ‘fast track’ pathway to avoid biliary stenting and hope to maximise the potential benefits of this system. The Health Service Management Centre at the University of Birmingham are experts in health policy and management, including assessments of local health systems, performance management and governance. Current and recent projects have been funded by large, national funding bodies such as the National Institute for Health Research. It is hoped that the combined resources of the two teams and in particular the novel involvement of the Health Service Management team will allow unique insights into the challenges that face the successful implementation of early pancreatic surgery.

The specific aim of this study is to understand the challenges to successfully delivering pancreatic surgery within the NHS without the need for biliary stenting. Lessons learnt will hopefully be transferrable throughout the NHS.