220 Fast-Track Surgery for Operable Pancreatic Cancer: Reflections and lessons learnt 12 Months Post-Implementation

Abstract Aim In 2024, the national Getting It Right First Time (GIRFT) initiative recommended the implementation of a Fast-Track pathway for operable pancreatic cancer at Oxford University Hospitals NHS Trust (OUH). The goal was to operate within 15 days of diagnosis, reducing delays and avoiding complications associated with pre-operative biliary drainage seen in standard care. Prior to Fast-Track implementation, OUH performed 54 pancreaticoduodenectomies in 2024, with a mean time from diagnosis to surgery of 47 days and biliary drainage-related complications in 20% of patients. Method An anonymous online survey was conducted 12 months after Fast-Track implementation. The survey (5–10 minutes to complete) included Likert-scale and free-text questions on clinical outcomes, operational factors, organisational impact, and areas for improvement. Results At the time of submission, eleven of eighteen (11/18) hepatobiliary department members had responded (three consultants, two registrars, one CNS, two dietitian, one hospital manager and one secretary). Respondents felt that good communication and multidisciplinary teamwork contributed significantly to early success. Surgical outcomes were perceived as similar to standard care. 6/11 (55%) responders felt that the hospital did not have adequate resources to sustain the pathway. Key challenges included lack of a dedicated pathway coordinator, limited access to elective theatre lists, and absence of a digital referral platform. Conclusions Introduction of the Fast-Track pathway has been resource-intensive, with referrals coordinated by the on-call consultant. To sustain and optimise a Fast-Track pathway, clinicians emphasise the importance of a dedicated coordinator and integrated digital systems to support the referral process.