JMIR Publications

ABSTRACT

Introduction: There are perceived variations in the management of patients with suspected pancreatic and periampullary cancers and/or malignant biliary obstruction. These variations may be due to a number of organisational, institutional and patient factors that could affect outcomes for those with curable or incurable disease. The RICOCHET study will be the first to provide a snapshot of investigative pathways across the UK in this patient group to reflect real-world practice. It is contemporary to new national and international clinical guidance and possibly could inform future local and national strategic planning to optimise care for patients with suspected HPB malignancies. The aim of this study is to define national variation in the investigative and management pathways of patients with suspected hepatopancreaticobiliary (HPB) malignancies and determine the effect of these variations on patient outcomes. Methods and Analysis: This is a nationwide, multicentre, prospective study. It is trainee-led through collaboration between surgical and medical specialties. Patients with suspected pancreatic cancer, other peri-ampullary cancer or extrahepatic cholangiocarcinoma presenting to hospitals in the United Kingdom (UK) will be identified over 90 days. Each case will be followed up for 90 days to collect data on the mode of presentation, investigations, interventions, use of local and specialist multidisciplinary team meetings and transfer of care between hub and spoke sites. Furthermore, the study will define dates and intervals between key points in the patient pathway. Discussion: RICOCHET is a multidisciplinary, multicentre, prospective observational study that aims to highlight variabilities in practice and to determine whether these affect the outcomes of patients with HPB malignancies. This is a trainee-led initiative that utilises a novel design to achieve full coverage of the different diagnostic and management pathways. RICOCHET may provide evidence to develop a more standardised approach to managing patients with suspected HPB malignancy.