Development and preliminary clinical characterization of an MDT-defined surgical-window framework for complex pancreatic cancer: a retrospective cohort study
Year: 2026
Type: article
Study design: Observational Study
Abstract: Background: Patients with complex pancreatic cancer, including those with challenging local vascular anatomy, liver oligometastases, obstructive jaundice, gastrointestinal bleeding, or severe pain, often fall into a guideline grey zone not fully addressed by conventional stage- or resectability-based algorithms. We characterized how a multidisciplinary team (MDT)-guided surgical-window framework was implemented and the downstream clinical course following the resulting treatment decisions. Methods: We retrospectively reviewed 37 patients with complex pancreatic cancer discussed by the MDT at a tertiary academic center (Department of Hepatobiliary Surgery, Peking University People's Hospital, Beijing, China) between November 2017 and November 2020 and followed through November 30, 2022. Patients were characterized according to the realized MDT-guided pathway: a surgery-inclusive surgical-window pathway (n=20) or a non-surgical-window pathway (n=17). The analysis focused on pathway realization, disease-control patterns, functional and symptom status, and exploratory descriptive overall survival (OS), with progression-free survival (PFS) retained as a secondary descriptive time-to-event outcome. Because pathway assignment was clinically selected and incorporated evolving post-baseline information, clinical outcomes were summarized descriptively without formal between-pathway hypothesis testing. Results: Nine of 37 index MDT decisions (24.3%) involved a surgery-inclusive strategy outside standard guideline-supported surgical indications, all in highly selected patients with stage IV low-burden metastatic disease. Functional status was summarized both as composite survival-functional states and among survivors at each assessment time point, with all between-pathway differences interpreted descriptively. Conclusions: In this single-center retrospective cohort, the MDT-defined surgical-window framework provided a structured way to integrate anatomy, metastatic burden, symptoms, treatment tolerance, and feasibility of subsequent care into individualized treatment decisions. The observed downstream disease-control, functional, symptom, and survival patterns are hypothesis-generating and do not establish a causal benefit of surgery or of MDT itself. Prospective studies with baseline-defined decisions are needed to validate the clinical usefulness of this framework.
Institutions: Peking University, Peking University People's Hospital
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: diamond
OpenAlex ID: W7224092038