title: International Association of Pancreatology (IAP)/European Pancreatic Club (EPC) consensus review of guidelines for the treatment of pancreatic cancer.
abstract: BACKGROUND
  Pancreatic cancer is one of the most devastating diseases with an extremely high mortality. Medical organizations and scientific societies have published a number of guidelines to address active treatment of pancreatic cancer. The aim of this consensus review was to identify where there is agreement or disagreement among the existing guidelines and to help define the gaps for future studies.
  
  
  METHODS
  A panel of expert pancreatologists gathered at the 46th European Pancreatic Club Meeting combined with the 18th International Association of Pancreatology Meeting and collaborated on critical reviews of eight English language guidelines for the clinical management of pancreatic cancer. Clinical questions (CQs) of interest were proposed by specialists in each of nine areas. The recommendations for the CQs in existing guidelines, as well as the evidence on which these were based, were reviewed and compared. The evidence was graded as sufficient, mediocre or poor/absent.
  
  
  RESULTS
  Only 4 of the 36 CQs, had sufficient evidence for agreement. There was also agreement in five additional CQs despite the lack of sufficient evidence. In 22 CQs, there was disagreement regardless of the presence or absence of evidence. There were five CQs that were not addressed adequately by existing guidelines.
  
  
  CONCLUSIONS
  The existing guidelines provide both evidence- and consensus-based recommendations. There is also considerable disagreement about the recommendations in part due to the lack of high level evidence. Improving the clinical management of patients with pancreatic cancer, will require continuing efforts to undertake research that will provide sufficient evidence to allow agreement.
authors.affiliation: Department of Surgery, Kyoto University Graduate School of Medicine, Kyoto, Japan. Electronic address: takaori@kuhp.kyoto-u.ac.jp.
authors.forename: Kyoichi
authors.initials: K
authors.lastname: Takaori
authors.affiliation: Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Academic Unit of Surgery, University of Glasgow, Glasgow, United Kingdom.
authors.forename: Andrew
authors.initials: A
authors.lastname: Biankin
authors.affiliation: Department of Radiation Oncology, University Hospitals Freiburg, Germany.
authors.forename: Thomas B
authors.initials: TB
authors.lastname: Brunner
authors.affiliation: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors.forename: Ivana
authors.initials: I
authors.lastname: Cataldo
authors.affiliation: Department of Pathology, Royal Liverpool University Hospital, Liverpool, United Kingdom.
authors.forename: Fiona
authors.initials: F
authors.lastname: Campbell
authors.affiliation: Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom.
authors.forename: David
authors.initials: D
authors.lastname: Cunningham
authors.affiliation: Pancreatic Surgery Unit, Università Vita e Salute, Milano, Italy.
authors.forename: Massimo
authors.initials: M
authors.lastname: Falconi
authors.affiliation: HPB Surgical Unit, Department of Surgery and Cancer, Imperial College, Hammersmith Hospital, London, United Kingdom.
authors.forename: Adam E
authors.initials: AE
authors.lastname: Frampton
authors.affiliation: Department of Medical Oncology, Kyorin University School of Medicine, Tokyo, Japan.
authors.forename: Junji
authors.initials: J
authors.lastname: Furuse
authors.affiliation: Endoscopic Unit, Paoli-Calmettes Institute, Marseille, France.
authors.forename: Marc
authors.initials: M
authors.lastname: Giovannini
authors.affiliation: NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: Richard
authors.initials: R
authors.lastname: Jackson
authors.affiliation: Department of Radiation Oncology and Image-applied Therapy, Kyoto University Hospital, Kyoto, Japan.
authors.forename: Akira
authors.initials: A
authors.lastname: Nakamura
authors.affiliation: Division of General Surgery, Yale University, New Haven, CT, United States of America.
authors.forename: William
authors.initials: W
authors.lastname: Nealon
authors.affiliation: NIHR Pancreas Biomedical Research Unit, Department of Molecular and Clinical Cancer Medicine, University of Liverpool, Liverpool, United Kingdom.
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.affiliation: Epithelial Carcinogenesis Group, CNIO-Spanish National Cancer Research Centre, Madrid, Spain.
authors.forename: Francisco X
authors.initials: FX
authors.lastname: Real
authors.affiliation: Department of Pathology and Diagnostics, University of Verona, Verona, Italy.
authors.forename: Aldo
authors.initials: A
authors.lastname: Scarpa
authors.affiliation: Department of Medicine, The Royal Marsden NHS Foundation Trust, London and Surrey, United Kingdom.
authors.forename: Francesco
authors.initials: F
authors.lastname: Sclafani
authors.affiliation: Department of Surgery, University of Auckland, HBP/Upper GI Unit, Auckland City Hospital, Auckland, New Zealand.
authors.forename: John A
authors.initials: JA
authors.lastname: Windsor
authors.affiliation: Department of Advanced Treatment of Pancreatic Disease, School of Medicine, University of Occupational and Environmental Health, Kitakyushu, Japan.
authors.forename: Koji
authors.initials: K
authors.lastname: Yamaguchi
authors.affiliation: Department of Surgery, The Johns Hopkins University, Baltimore, MD, United States of America.
authors.forename: Christopher
authors.initials: C
authors.lastname: Wolfgang
authors.affiliation: University Surgical Unit, Southampton General Hospital, Southampton, United Kingdom.
authors.forename: Colin D
authors.initials: CD
authors.lastname: Johnson
mesh_terms: D000970:Antineoplastic Agents / Q000627:therapeutic use*; D006801:Humans; D010190:Pancreatic Neoplasms / Q000175:diagnosis / Q000628:therapy*; D017410:Practice Guidelines as Topic
chemical_list: D000970:Antineoplastic Agents
keywords: Chemotherapy; Guidelines; Pancreatic cancer; Pathology; Radiation; Surgery