Authors:

Abstract

Introduction: Pancreatic adenocarcinoma is the 5th leading cause of cancer death in the UK. Surgical resection remains the only curative option, however more than 80% of patients with pancreatic cancer present with unresectable disease. There is wide variation in the diagnostic and management pathway for these patients, including the pathway to surgery and management of biliary obstruction. Furthermore, there is no standard framework for the palliation of unresectable disease. There is a lack of evidence in this area and the purpose of this study is to assess whether this perceived variability in treatment pathways is affecting patient outcomes and experience.

Aim: The overall aim of this study is to deliver a snapshot of investigative and management practice for patients with newly identified pancreatic cancer or suspicious periampullary tumour.

Study Design: RICOCHET is a multicentre, national, prospective study of resectable and unresectable pancreatic and periampullary cancers from point of presentation to treatment. It is an ambitious cross speciality study that will be delivered through collaboration between surgical and gastroenterology trainees with involvement from oncology, palliative care and nutritional teams. All patients presenting with suspected pancreatic or periampullary cancer during a 90 day collection period will be included, with a 90 day follow up. Patients will be identified though the HPB/UGI MDT, and the clinical nurse specialists. Individual patient pathways will be mapped across different hospitals they attend. All diagnostic investigations, interventions and associated complications, nutritional and palliative input and receipt of chemotherapy will be recorded.

Conclusion: We believe that knowledge of the factors that influence management decisions and outcomes will effect a positive change in patient outcome, utility of hospital resources and allow optimal service delivery planning. Understanding the patient pathway and the variation in this across the country will also provide detail for trial design.