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. 2021 Apr 1;13(7):1669. doi: 10.3390/cancers13071669

Table 4.

Pre-operative areas for potential gain.

Areas for Gain Pre-Operatively Problem Intervention Gain
Avoidance of pre-operative biliary drainage
  • -

    PBD related complications are common

  • -

    Avoidable delay to surgery

  • -

    Missed window of opportunity for curative surgery
  • -

    Upfront surgery
  • -

    Avoid PBD related complications

  • -

    Reduce postoperative complications

  • -

    Increase number of patients undergoing curative surgery

  • -

    Improve overall survival
Correction of PEI related malnutrition
  • -

    PEI is highly prevalent and related to weight loss, reduced QoL, reduced survival

  • -

    Under-prescribing of PERT

  • -

    Inadequate dosing

  • -

    Malnourished at baseline

  • -

    Sarcopenia
  • -

    PERT prescribing for all

  • -

    Education of wider team

  • -

    Patient education

  • -

    Dietetic monitoring

  • -

    Consider PPI

  • -

    Consider supplements
  • -

    Improve quality of life

  • -

    Reduce weight loss

  • -

    Reduce complications

  • -

    Improve survival
Prehabilitation
  • -

    Older age group

  • -

    Sarcopenia

  • -

    Too ‘frail’ for treatment

  • -

    Deconditioning
  • -

    Consider who is ‘at risk’

  • -

    Physiotherapy involvement

  • -

    More research
  • -

    Potential to reduce some complications

  • -

    Reduce length of stay

  • -

    Potential to improve access to treatment
Old age/frailty
  • -

    Nihilistic attitudes towards older age

  • -

    Elderly not receiving same standard of care despite proven benefit
  • -

    MDT decision making with geriatrician if able

  • -

    Use of assessment tools. Such as CGA

  • -

    Co-morbidities rather than chronological age as deciding factor.
  • -

    Improved access to curative treatment options for the elderly.

PEI = Pancreatic exocrine insufficiency, PBD = Pre-operative biliary drainage, QoL = Quality of life, PERT = Pancreatic enzyme replacement therapy, PPI = Proton pump inhibitor, CGA = Comprehensive geriatric assessment.