The use of an app in the daily evaluation following pancreatic surgery gives healthcare providers the chance to achieve a significant reduction in severe problems and death in patients with pancreatic cancer because of that surgery. This was demonstrated by a national study of the 16 Dutch hospitals that perform pancreatic surgeries. The results of this study were published today in the renowned scientific journal The Lancet.

The surgical removal of the pancreas is a complicated procedure. This surgery is performed mainly on people with pancreatic cancer, to remove the tumor as effectively as possible. Dutch surgeons perform approximately 1000 pancreatic surgeries each year, divided over 16 hospitals. These surgeries take place within the alliance of the Dutch Pancreatic Cancer Group (DPCG).

Approximately 1 in 3 patients are faced with complications after the surgery. The most common complication is the leakage of fluid from the surgical field into the abdominal cavity. This can have severe consequences, such as sepsis, internal bleeding, and even premature death.

Act as quickly as possible when complications occur after the surgery
Usually, the doctors only treat these complications once a patient deteriorates. The researchers of this study wanted to test a new approach: whether treating complications at an earlier stage – before the patient becomes ill – would result in less severe consequences.

“We want to be able to intervene as quickly as possible if problems occur after the surgery. We can achieve this through early diagnosis and treatment of complications,” according to Hjalmar van Santvoort, on behalf of the DPCG. He is a pancreatic surgeon and operates both in the St. Antonius Hospital in Utrecht and Nieuwegein and in the UMC Utrecht and he is one of the lead researchers of this study.

App gives advice for further examination or treatment
To achieve the objective, the study team developed an app that doctors and nurses can use to monitor the patient in the days after the surgery. The healthcare providers enter data in the app that they obtain from the daily post-operative monitoring, such as the heart rate, blood pressure, drain output from the surgical field and the white blood cell count.

The healthcare providers usually record these data in the electronic patient file (EPD). The information is stored there, but the EPD does not offer any advice on what to do in the event of an impending complication. The app does offer advice: the app uses the data it receives to give the healthcare provider advice about additional examination or treatment, to prevent severe problems. 

For example, the app indicates whether antibiotics are required, whether the doctor should request an extra abdominal CT scan, when the drains (tubes that drain fluid) can be removed and when extra drains are required. The algorithm that offers the advice was created based on various international literature studies and consensus studies, based partly on a retrospective analysis of patient data. The research team spent several years working on the development of the app.

National collaboration to study the added benefit of the app
The app was studied in all 16 Dutch hospitals where surgeons perform pancreatic surgeries. The study lasted almost 2 years. The most important result: the use of the app halved the number of patients dying because of the surgery. The risk of death after this complex procedure was 5% without use of the app. Use of the app reduced this risk to 2.7%.

Jasmijn Smits, physician-researcher, says about the results: "We expected that this way of working would have an effect on reducing complications. That the effect on reducing mortality would be so big, is beyond expectation. The study shows that identifying possible complications and acting on them in an earlier phase halves the risk of death. A very valuable outcome for healthcare providers and especially for the group of patients who, unfortunately, usually already have a limited life expectancy."

Use and further development of the app
Now that this study has proven the added value, the DPCG recommends the use of the app in post-operative monitoring. The Pancreatic Surgery app is available free of charge to all healthcare providers in the Apple and Android app stores and it is in English, meaning that it can be used internationally. The study team wants to optimize the app further using the clinical data that will become available in daily practice.

Henriëtte de Groot and Mariska Hoogendoorn-de Ruiter both work as specialist nurses on the GE surgery ward (abdominal surgery) in the St. Antonius Hospital. “The app is very easy to use. It only takes a minute to answer the questions and really helps to offer good patient care,” according to Henriëtte. Mariska adds: “The patients informed us that they were also happy to hear that we were using the app. This gave them certainty that they were being closely monitored. That is reassuring for the patients, particularly after such major surgery.”

The researchers also see possibilities for adjusting the algorithm, so that the app would also be suitable for other complicated procedures with a high risk of complications. Examples include surgery of the rectum, esophagus, and liver. These patients will also have a lower risk of death in the future.

More information
This research was partly funded by KWF Dutch Cancer Society and the Alexandre Suerman stipendium of UMC Utrecht.

Useful links

• Download this app in the app store for iPhone or Android
• Scientific article about this research in The Lancet
• Profile page Hjalmar van Santvoort in UMC Utrecht and the St. Antonius Hospital
• Regional Academic Cancer Center Utrecht (RAKU) is a collaboration of 5 hospitals in the Utrecht region for the treatment of abdominal tumors
• National working group pancreatic cancer: Dutch Pancreatic Cancer Group (DPCG)