The impact of a new hepatopancreatobiliary surgery program on the management of pancreatic cancer at Health Sciences North

Background: Centralization of specialist services to urban centres presents a challenge to patients living in rural communities. The hepatopancreatobiliary surgery (HPB) program at Health Sciences North (HSN) is the tenth and newest HPB centre by Cancer Care Ontario and presents a unique opportunity to evaluate the barriers to delivering HPB cancer care to patients in northern Ontario. Methods: We retrospectively reviewed the cases of patients referred to the Northeastern Ontario Cancer Centre and HSN with a pancreatic cancer diagnosis between 2009 and 2015. July 2013 marked the inception of the HPB surgical program. Our primary outcome was time to HPB surgical consultation. Secondary outcomes included distance of travel and time to curative intent operation. Results: Our population consisted of 207 patients (98 pre-HPB v. 109 post-HPB). Median time to consultation with an HPB surgeon was decreased in the post-HPB group (43 v. 11 d, p < 0.001). An increased proportion of patients with pancreatic malignancies in the post-HPB group received HPB surgical consultations (34% v. 74%, p < 0.001), with decreased median distance travelled to surgical consultation (411 v. 79 km, p < 0.001). Time to curative intent operation or medical oncology consultation did not significantly increase. Conclusion: A new HPB program appears to have facilitated the proportion of patients with pancreatic malignancies at HSN receiving an HPB surgical consultation. Patients received complex surgeries, closer to their home regions. It is anticipated that these changes may affect overall outcomes and patient satisfaction and will be the focus of future investigations.

Contexte: La concentration des services spécialisés dans les centres urbains pose un défi pour les patients des communautés rurales. Le programme de chirurgie hépatopancréatobiliaire (HPB) d'Horizon Santé-Nord (HSN) est le 10e et plus récent centre HPB d'Action Cancer Ontario; il offre une occasion unique d'évaluer les obstacles à la prestation des soins oncologiques HPB aux patients du Nord de l'Ontario. Méthodes: Nous avons passé en revue de manière rétrospective les cas adressés au Centre de cancérologie du Nord-Est de l'Ontario et à HSN pour un diagnostic de cancer du pancréas entre 2009 et 2015. Le programme chirurgical HPB a été lancé en juillet 2013. Notre principal paramètre était le délai d'obtention d'une consultation pour une chirurgie HPB. Les paramètres secondaires incluaient la distance à parcourir et le délai d'obtention d'une intervention à visée curative. Résultats: Notre population comportait 207 patients (98 pré-HPB c. 109 post-HPB). Le délai médian d'obtention de la consultation en chirurgie HPB a diminué dans le groupe post-HPB (43 j c. 11 j, p < 0,001). Une proportion plus grande de patients atteints de cancer du pancréas dans le groupe post-HPB a obtenu une consultation pour chirurgie HPB (34 % c. 74 %, p < 0,001), et une diminution de la distance médiane à parcourir pour se rendre à la consultation a été constatée (411 km c. 79 km, p < 0,001). Le délai d'obtention de la chirurgie à visée curative ou de la consultation en oncologie médicale n'a pas augmenté significativement. Conclusion: Le nouveau programme HPB semble avoir permis d'accroître la proportion de patients atteints de cancer du pancréas ayant pu bénéficier d'une consultation pour chirurgie HPB. Les patients ont pu subir des chirurgies complexes plus près de chez eux. On prévoit que ces modifications auront une incidence sur les paramètres globaux et la satisfaction des patients et qu'elles feront l'objet d'études.

Higher Hepatic miR-29 Expression in Undernourished Male Rats During the Postnatal Period Targets the Long-Term Repression of IGF-1.

A nutritional mismatch in postnatal life of low birth weight offspring increases the risk of developing the metabolic syndrome. Moreover, this is associated with decreased hepatic Igf1 expression, leading to impaired growth and metabolism. Previously, we have demonstrated that the timing of nutritional restoration in perinatal life can differentially program hepatic gene expression. Although microRNAs also play an important role in silencing gene expression, to date, the impact of a nutritional mismatch in neonatal life on their long-term expression has not been evaluated. Given the complementarity of miR-29 to the 3' untranslated region of Igf1, we examined how protein restoration in maternal protein restriction rat offspring influences hepatic miR-29 and Igf1 expression in adulthood. Pregnant Wistar rats were designated into 1 of 4 dietary regimes: 20% protein (control), 8% protein during lactation only (LP-Lact), 8% protein during gestation only (LP1) or both (LP2). The steady-state expression of hepatic miR-29 mRNA significantly increased in LP2 offspring at postnatal day 21 and 130, and this was inversely related to hepatic Igf1 mRNA and body weight. Interestingly, this reciprocal association was stronger in LP-Lact offspring at postnatal day 21. Functional relevance of this in vivo relationship was evaluated by transfection of miR-29 mimics in neonatal Clone 9 rat hepatoma cells. Transfection with miR-29 suppressed Igf1 expression by 12 hours. Collectively, these findings implicate that nutritional restoration after weaning (post liver differentiation) in maternal protein restriction rat offspring fails to prevent long-term impaired growth, in part, due to miR-29 suppression of hepatic Igf1 expression.