Background: Preoperative planning of patients diagnosed with pancreatic head cancer is difficult and requires specific expertise. This pilot study assesses the added value of three-dimensional (3D) patient models and computer-aided detection (CAD) algorithms in determining the resectability of pancreatic head tumors. Methods: This study included 14 hepatopancreatobiliary experts from eight hospitals. The participants assessed three radiologically resectable and three radiologically borderline resectable cases in a simulated setting via crossover design. Groups were divided in controls (using a CT scan), a 3D group (using a CT scan and 3D models), and a CAD group (using a CT scan, 3D and CAD). For the perceived fulfillment of preoperative needs, the quality and confidence of clinical decision-making were evaluated. Results: A higher perceived ability to determine degrees and the length of tumor–vessel contact was reported in the CAD group compared to controls (p = 0.022 and p = 0.003, respectively). Lower degrees of tumor–vessel contact were predicted for radiologically borderline resectable tumors in the CAD group compared to controls (p = 0.037). Higher confidence levels were observed in predicting the need for vascular resection in the 3D group compared to controls (p = 0.033) for all cases combined. Conclusions: “CAD (including 3D) improved experts’ perceived ability to accurately assess vessel involvement and supports the development of evolving techniques that may enhance the diagnosis and treatment of pancreatic cancer”.

Introduction: The ESMO and ECIO-ESOI consensus guidelines vary in their recommendations regarding the use of ¹⁸F-Fluorodeoxyglucose ([¹⁸F]FDG) PET/CT in the follow-up after thermal ablation in patients with colorectal liver metastases. This is partly because studies providing data on long-term benefits of [¹⁸F]FDG PET/CT are lacking. Therefore, a simulation model was developed to examine how follow-up with [¹⁸F]FDG PET/CT impacts treatment planning, health and cost outcomes. Methods: For an illustrative Dutch cohort, lifetime health and cost outcomes were simulated to assess the cost-effectiveness of performing a single additional [¹⁸F]FDG PET/CT. Patients followed a standard surveillance schedule consisting of three-monthly serum CEA and contrast-enhanced CT, plus [¹⁸F]FDG PET/CT 3–4 months after thermal ablation. Therapy could be repeated downstream the care pathway. Quality-of-life and survival estimates were based on disease stage and age. Costs were determined from a healthcare perspective incorporating costs related to diagnostics and treatments. The Consolidated Health Economic Evaluation Reporting Standards were followed. Results: Health benefits of additional [¹⁸F]FDG PET/CT were negligible, incremental QALYs < 0.001, whereas costs increased by €1,277, mainly due to the additional imaging. This lack of health benefits can be explained by the small subset of simulated patients (<5 %) in whom [¹⁸F]FDG PET/CT affected treatment planning. Discussion: Additional [¹⁸F]FDG PET/CT 3–4 months after thermal ablation is unlikely to be cost-effective. More research is needed to determine if using [¹⁸F]FDG PET/CT in subgroups of patients, or at alternative time points, is cost-effective. This requires collecting more (extensive) follow-up data across multiple centres to reflect heterogeneity between hospitals’ clinical practices.

Background: In some patients with colorectal liver metastases it is not clear whether liver resection or isolated liver perfusion is the best treatment option. For instance, the risk of complications after surgery may be so substantial and affect subsequent survival. Aim of the present study is to compare complication occurrence and its effect on survival after liver resection and perfusion. Methods: Patient records of all 225 patients with colorectal liver metastases treated with liver resection (n = 121) or liver perfusion (n = 104) in the period 1997-2006 were reviewed for complications during the initial hospitalisation until 30 d after discharge, and to assess patient survival until the last hospital visit. Median duration of follow-up was 38 mo for overall survival and 22 mo for survival after surgery. Results: Complications occurred less often in patients undergoing resection than perfusion (29.8% versus 49.0%, X² = 8.77, P < 0.01). Postoperative mortality rates were similar in both groups (4.1% and 4.8%, respectively). As expected, long term survival after liver surgery was better in the resection group: at 3 y, 60% of patients survived in the resection group, compared with 22% after liver perfusion (log rank X² = 35.29 P < 0.001). However, liver resection patients with postoperative complications, had similar survival as perfusion patients without complications (log rank X² = 2.45, p = 0.12). This remained after adjustment for differences between the patient groups at time of surgery. Conclusion: Liver resection has superior long-term survival, but survival is significantly reduced by the occurrence of post-surgical complications. When complications occur after liver resection, survival is comparable to patients who underwent uncomplicated liver perfusion.