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Background Pancreatic cancer surgery has a multi-system impact on a potentially vulnerable population. Current rates of adjuvant chemotherapy uptake are low. Our group developed a multidisciplinary bundle of care with the aim of improving recovery after surgery. The primary aim was to improve uptake of adjuvant chemotherapy and the secondary aim was to prevent nutritional decline. Methods This prospective, observational, cohort study evaluated the effect of the ‘Fast Recovery’ programme. This programme, developed with input from dieticians, physiotherapists, surgeons, and geriatricians and comprising pre- and post-operative frailty assessments, nutritional support and physiotherapy was implemented for all within our unit undergoing pancreatic resection for cancer. (See Fig. 1) Results Over 1 year, patients enrolled in the Fast Recovery programme (N = 44) were compared to those treated prior to the pathway change (N = 409). The Fast Recovery programme was not associated with a significant increase of adjuvant chemotherapy uptake (80.5 vs. 74.3%, p = 0.452), but did lead to a significantly lower average weight loss (4.3 vs. 6.9kg, p = 0.013). Patients that did not receive adjuvant chemotherapy performed significantly worse on a pre-operative six minute walk test (mean distance: 277 vs. 454 metres, p = 0.001). Conclusions Feasibility of a multimodal package to improve patient care following pancreatic resection has been shown by this pilot study. No significant improvement in the chemotherapy uptake was observed, however, this was potentially a result of the study being underpowered. Pre-operative physical assessments were found to be predictive of adjuvant chemotherapy uptake and could potentially be used to identify those in need of additional support. Further work is needed to evaluate the routine use of such a programme.

british journal of surgery

P-P20 ‘Fast Recovery’ A multidisciplinary approach to improving recovery after pancreatic resection and ultimately increasing uptake of adjuvant chemotherapy