Quality statement 3: Resectional surgery

Quality statement

Adults with resectable pancreatic cancer and obstructive jaundice have resectional surgery rather than preoperative biliary drainage unless the drainage is specifically indicated.

Rationale

Prompt resectional surgery has the potential to increase positive outcomes for adults with resectable pancreatic cancer. For those who are well enough for resectional surgery and not enrolled in a clinical trial that requires biliary drainage, performing preoperative biliary drainage can delay surgery, increase complications and hospitalisations, and raise the risk of pre‑surgery pancreatitis compared with surgery alone. Carrying out the resection without performing biliary drainage also reduces costs.

Quality measures

Structure

Evidence of local care protocols, which ensure that adults with resectable pancreatic cancer and obstructive jaundice have resectional surgery without preoperative biliary drainage unless the drainage is specifically indicated.

Data source: Local data collection, for example service protocols, regional network arrangements, documented local referral policies or agreed patient pathways.

Process

Proportion of adults with resectable pancreatic cancer and obstructive jaundice with no indication for preoperative biliary drainage who had resectional surgery without the drainage.

Numerator – the number in the denominator who had resectional surgery without preoperative biliary drainage.

Denominator – the number of adults with resectable pancreatic cancer and obstructive jaundice with no indication for preoperative biliary drainage.

Data source: Local data collection, for example patient records.

Outcome

a) Time to resectional surgery for adults with resectable pancreatic cancer and obstructive jaundice.

Data source: NHS England's cancer waiting times.

b) Disease-free survival in adults with resectable pancreatic cancer and obstructive jaundice who had resectable surgery without preoperative biliary drainage.

Data source: Local data collection, for example patient records.

c) Overall survival in adults with resectable pancreatic cancer.

Data source: Local data collection, for example patient records.

d) Health-related quality of life in adults with pancreatic cancer.

Data source: Local data collection, for example surveys carried out with people with pancreatic cancer or their families.

What the quality statement means for different audiences

Service providers (secondary and tertiary services and specialist regional centres) ensure that systems are in place for adults with resectable pancreatic cancer to have resectional surgery as soon as possible. This includes ensuring that adults with resectable pancreatic cancer and obstructive jaundice have resectional surgery rather than preoperative biliary drainage if they are well enough for surgery and if they are not enrolled in a clinical trial that requires preoperative biliary drainage.

Healthcare professionals (such as gastroenterologists, surgeons and interventional radiologists) are aware of the local pathways for pancreatic cancer and understand that adults with resectable pancreatic cancer should have resectional surgery as soon as possible. They ensure that all adults with resectable pancreatic cancer and obstructive jaundice have resectional surgery without unnecessary delays such as performing preoperative biliary drainage, if they are well enough for surgery and are not enrolled in a clinical trial that requires preoperative biliary drainage.

Commissioners (NHS England and clinical commissioning groups) ensure that they commission services that carry out resectional surgery in adults who have resectable pancreatic cancer without unnecessary delays. They ensure that preoperative biliary drainage is not carried out unnecessarily in adults with resectable pancreatic cancer and obstructive jaundice who are well enough for surgery and are not enrolled in a clinical trial that requires this procedure.

Adults with pancreatic cancer and jaundice who are well enough to have an operation to remove their tumour can have the operation without needing to have their jaundice treated first, unless they are in a clinical trial that requires the jaundice to be treated.

Source guidance

Pancreatic cancer in adults: diagnosis and management (2018) NICE guideline NG85, recommendation 1.7.1

Definitions of terms used in this quality statement

Specific indications for biliary drainage in adults with resectable pancreatic cancer and obstructive jaundice

  • Not being well enough for resectional surgery.

  • Being enrolled in a clinical trial that requires preoperative biliary drainage.

[NICE's guideline on pancreatic cancer in adults, recommendation 1.7.1]