Early stage pancreatic cancer: Minimally invasive surgery works and speeds recovery
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Less is more. A way of saying that from today can also be applied to pancreatic tumor surgery. Because – at least for those in the initial phase – it has been seen that minimally invasive techniques are just as effective as traditional ones. And this is no small news not only because it comes from Asco, the most important world cancer congress which this year sees the participation of about 40,000 experts from all over the world, but also because it means faster recovery times and less risk of infection for patients.
The skepticism of surgeons
An estimated 64,050 adults in the United States will be diagnosed with pancreatic cancer in 2023, and only 12% of early stage cancer, when surgical removal of the tumor is possible. The 5-year survival rate in pancreatic cancer that can be treated with surgery is 44%. Open distal pancreatectomy uses one large incision, while minimally invasive pancreatectomy uses several small incisions. During the operation, the spleen is also removed for further lymph node sampling. Previous research comparing the two surgical techniques were systematic reviews showing similar results. However, one-third of pancreatic surgeons surveyed raised questions about the safety and efficacy of minimally invasive surgery compared to open surgery. The Diploma study presented at Asco demonstrates that minimally invasive distal pancreatectomy is a viable option for patients with early-stage pancreatic cancer.
I study
DIPLOMA is the first randomized, blinded study comparing the outcomes of open and minimally invasive surgery in patients with early stage pancreatic cancer when the disease is on the body or tail of the pancreas. It is a non-inferiority study comparing one traditional procedure with another to confirm that the new treatment is no worse than the standard of care. The two surgical techniques show comparable results. The primary endpoint of the study was radical resection, or complete removal of the tumor and some surrounding tissue. Between May 2018 and May 2021, we studied the cases of 258 patients with resectable pancreatic cancer from 35 centers in 12 countries. 117 patients were operated on with minimally invasive, laparoscopic or robotic surgery, and 114 patients with open surgery”.
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The results
Radical resection, or complete removal of the tumor with some surrounding healthy tissue, was performed in 83 patients (73%) with minimally invasive surgery and in 76 patients (69%) with traditional surgical techniques, which involve a long incision. The results obtained in the two groups are similar, and for the first time it has been demonstrated that minimally invasive distal pancreatectomy is a valid surgical option for patients with resectable pancreatic cancer. It is the first randomized study comparing the two surgical techniques in pancreatic cancer, providing reassurance to patients and doctors that the minimally invasive option involving a few small incisions is valid and effective. “This surgical approach, which removes tumors located on the body and tail of the pancreas and spleen, uses small incisions with a lower risk of serious complications than open surgery,” he explains Moh’d Abu Hilaldirector of the General Surgery Unit and of the Hepatobiliopancreatic, Robotic and Minimally Invasive Surgery Unit of the Poliambulanza Foundation of Brescia, who initiated the study and coordinated the centers involved in the trial.
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Effects after surgery
Postoperatively, the researchers noted that the number of lymph nodes removed during surgery, or average lymph node yield, was 22 in the minimally invasive group and 23 in the open group. The minimum lymph node yield for a successful distal pancreatectomy is 13 lymph nodes. Intraperitoneal recurrence, or recurrence occurring in the peritoneal cavity, was 41% in the minimally invasive group and 38% in the other. “Surgery has made significant strides in the past 20 years. One of the most important is the introduction of the minimally invasive technique. For the first time, we also have confirmation in pancreatic cancer that minimally invasive distal pancreatectomy is as valid as open surgery”. The researchers will continue to follow up on these patients to compare the 3- and 5-year results, and further analysis of the samples taken during this study will look at the number of lymph nodes removed in the spleen to determine if the spleen needs to be removed. The researchers will also conduct further studies to compare results between laparoscopic and robotic minimally invasive surgical techniques.
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New options for patients
The enthusiasm of Prof. Abu Hilal: “Our research provides reassurance to surgeons and can help patients by giving them the information they need to make a treatment decision together with their doctor. With these results, I can say that I am very happy for the many patients in different parts of the world who can benefit from this approach. I do not hide my personal satisfaction having been the promoter of the minimally invasive approach since 2007. In fact, the minimally invasive technique described in this work had already been presented by me and my group in 2016″.
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