E286: Synoptic Preoperative Evaluation Of Hepatopancreaticobiliary Cancer: An Institutional Experience

Synoptic dictations are checklists or templates, often in the form of smart phrases or smart tools within an electronic medical record, which contain standardized elements. There has been a rising interest in utilizing these templates for cancer care, including operative, radiology, and pathology dictations.  However, there is a lack of readily available synoptic dictation template for the preoperative assessment of hepatopancreaticobiliary (HPB) cancer.

Methods:

A collaborative of expert liver and pancreas surgeons at our institution contributed to a formal standardized synoptic dictation template for the pre-operative assessment of patients with pancreatic, biliary, or liver cancer. First, the experts deliberated on the objectives and features that would be most important to these templates. Second, experts deliberated on the critical items that should be included or removed from each template. And third, the items from each template were organized and categorized in a comprehensive manner.  


Results:

The experts agreed that these templates should aim to (1) facilitate retrieval of critical information pertinent to the specific cancer, (2) facilitate decision-making pertaining to the next phase of cancer care, (3) decrease rate of incomplete pre-operative cancer work-up, (4) improve risk stratification, (5) and remain succinct and easily implementable. The experts stratified each template into six categories: (a) diagnosis, (b) risk factors, (c) condition, (d) radiographic data, (e) laboratory data, and (f) multidisciplinary evaluation.   The (a) diagnosis section aims to clarify the clinical presentation, the presence of tissue diagnosis, and the current phase of cancer care. The (b) risk factors section aims to assess the need for risk reduction counseling and genetic referral. The (c) condition section aims to assess the need for medical optimization, improved social support, pre-habilitation, nutritional and/or enzymatic supplementation. The (d) radiographic data section aims to assist with operative planning. The (e) laboratory data section aims to ensure adequate tumor marker and liver status evaluation, along with need for pre-operative vaccination.  The (f) multidisciplinary evaluation section aims to ensure early referral and multidisciplinary assessment of pancreatic, biliary and liver cancer. (Table 1) 

Conclusions:

A collaboration of hepatobiliary surgeons proposes easily implementable and succinct pre-operative synoptic dictation templates with the aim to improve HPB cancer work-up, data retrieval, risk stratification, and decision making. In our institutional experience, this approach resulted in improved data acquisition and availability.