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Cancers
Special Issues
Recent Updates on Surgical Treatment of Pancreaticobiliary Cancers
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Recent Updates on Surgical Treatment of Pancreaticobiliary Cancers

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Cancer Therapy".

Deadline for manuscript submissions: closed (10 March 2024) | Viewed by 1996

Special Issue Editor

Prof. Dr. Long R. Jiao

E-Mail Website
Guest Editor
Department of Academic Surgery, The Royal Marsden Hospital, 203 Fulham Rd., London SW3 6JJ, UK
Interests: surgical technology; cancer biology; pancreatic cancer

Special Issue Information

Dear Colleagues,

Surgery remains the gold standard for the treatment of pancreaticobiliary cancers with curative intent. Technological advancements over the last three decades in imaging such as MRI, CT and PET/CT scans and EUS have greatly improved the ability of surgeons to accurately diagnose, localize and plan surgical interventions for the pancreaticobiliary cancers. Furthermore, the improved outcome of chemotherapy and newly advocated immunotherapy as neoadjuvant treatment over the past few years have led to an increased number of cases suitable for surgical resection following downstaging. The past two decades have witnessed major advancement in surgery with the rapid emergence of minimally invasive surgery (MIS) leading to a total re-evaluation of conventional open surgical approaches across all specialties for faster recovery and reduced morbidity for patients undergoing surgical procedures. This is undoubtedly the future of surgery supported by artificial intelligence (AI) for preoperative planning, intraoperative guidance, and decision-making.

Despite the pioneering laparoscopic operation being a cholecystectomy, pancreaticobiliary operations are technically extremely difficult with laparoscopic techniques even in an expert HPB surgeon’s hands. Hence, while some other specialties achieve 70% of surgery using MIS, this is only true in less than 10% of pancreaticobiliary operations. In 2000, the Da Vinci robotic system (Intuitive Surgical Inc., Mountain View, CA) gained FDA approval. Robotic surgery has several advantages to the normal laparoscopic approach. It provides a three-dimensional visual field with depth perception. Its ‘wristed’ instruments provide the natural seven degrees of motional freedom, mimicking open surgery, while they are capable of scaled movements. These advances increase dexterity and improve hand-eye coordination, unlocking the ability to perform cases that were deemed unfeasible laparoscopically. However, high-volume tertiary centres, with trained HPB surgeons interested in MIS, are performing pancreaticobiliary resections with these techniques. That said, the advantages of robotic surgery can overcome the problems related to laparoscopic surgery by allowing us to perform more complex and difficult tasks with ease in hepatobiliary and pancreatic surgery and for more of our patients to safely undergo MIS; it also allows the standardization of the surgical steps and techniques of these complex operations and offers organ-sparing operations.

The aim of this Special Issue is to present readers the current trends and outcomes of surgical resection of pancreaticobiliary cancer and to set the standard of care for pancreaticobiliary cancer surgery.

Prof. Dr. Long R. Jiao
Guest Editor

Manuscript Submission Information

Manuscripts should be submitted online at www.mdpi.com by registering and logging in to this website. Once you are registered, click here to go to the submission form. Manuscripts can be submitted until the deadline. All submissions that pass pre-check are peer-reviewed. Accepted papers will be published continuously in the journal (as soon as accepted) and will be listed together on the special issue website. Research articles, review articles as well as short communications are invited. For planned papers, a title and short abstract (about 100 words) can be sent to the Editorial Office for announcement on this website.

Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreaticobiliary cancers
  • surgery
  • minimally invasive surgery
  • artificial intelligence
  • laparoscopic techniques

Published Papers (2 papers)

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Research

10 pages, 440 KiB  
Article
Timing of Initiation of Palliative Chemotherapy in Asymptomatic Patients with Metastatic Pancreatic Cancer: An International Expert Survey and Case-Vignette Study
by Simone Augustinus, Hanneke W. M. van Laarhoven, Geert A. Cirkel, Jan Willem B. de Groot, Bas Groot Koerkamp, Teresa Macarulla, Davide Melisi, Eileen M. O'Reilly, Hjalmar C. van Santvoort, Tara M. Mackay, Marc G. Besselink and Johanna W. Wilmink
Cancers 2023, 15(23), 5603; https://doi.org/10.3390/cancers15235603 - 27 Nov 2023
Viewed by 857
Abstract
Background: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment [...] Read more.
Background: The use of imaging, in general, and during follow-up after resection of pancreatic cancer, is increasing. Consequently, the number of asymptomatic patients diagnosed with metastatic pancreatic cancer (mPDAC) is increasing. In these patients, palliative systemic therapy is the only tumor-directed treatment option; hence, it is often immediately initiated. However, delaying therapy in asymptomatic palliative patients may preserve quality of life and avoid therapy-related toxicity, but the impact on survival is unknown. This study aimed to gain insight into the current perspectives and clinical decision=making of experts regarding the timing of treatment initiation of patients with asymptomatic mPDAC. Methods: An online survey (13 questions, 9 case-vignettes) was sent to all first and last authors of published clinical trials on mPDAC over the past 10 years and medical oncologists of the Dutch Pancreatic Cancer Group. Inter-rater variability was determined using the Kappa Light test. Differences in the preferred timing of treatment initiation among countries, continents, and years of experience were analyzed using Fisher’s exact test. Results: Overall, 78 of 291 (27%) medical oncologists from 15 countries responded (62% from Europe, 23% from North America, and 15% from Asia–Pacific). The majority of respondents (63%) preferred the immediate initiation of chemotherapy following diagnosis. In 3/9 case-vignettes, delayed treatment was favored in specific clinical contexts (i.e., patient with only one small lung metastasis, significant comorbidities, and higher age). A significant degree of inter-rater variability was present within 7/9 case-vignettes. The recommended timing of treatment initiation differed between continents for 2/9 case-vignettes (22%), in 7/9 (77.9%) comparing the Netherlands with other countries, and based on years of experience for 5/9 (56%). Conclusions: Although the response rate was limited, in asymptomatic patients with mPDAC, immediate treatment is most often preferred. Delaying treatment until symptoms occur is considered in patients with limited metastatic disease, more comorbidities, and higher age. Full article
(This article belongs to the Special Issue Recent Updates on Surgical Treatment of Pancreaticobiliary Cancers)
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9 pages, 269 KiB  
Article
Robotic Distal Pancreatectomy Yields Superior Outcomes Compared to Laparoscopic Technique: A Single Surgeon Experience of 123 Consecutive Cases
by Hao Ding, Michal Kawka, Tamara M. H. Gall, Chris Wadsworth, Nagy Habib, David Nicol, David Cunningham and Long R. Jiao
Cancers 2023, 15(22), 5492; https://doi.org/10.3390/cancers15225492 - 20 Nov 2023
Viewed by 845
Abstract
Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed [...] Read more.
Technical limitations of laparoscopic distal pancreatectomy (LDP), in comparison to robotic distal pancreatectomy (RDP), may translate to high conversion rates and morbidity. LDP and RDP procedures performed between December 2008 and January 2023 in our tertiary referral hepatobiliary and pancreatic centres were analysed and compared with regard to short-term outcomes. A total of 62 consecutive LDP cases and 61 RDP cases were performed. There was more conversion to open surgeries in the laparoscopic group compared with the robotic group (21.0% vs. 1.6%, p = 0.001). The LDP group also had a higher rate of postoperative complications (43.5% vs. 23.0%, p = 0.005). However, there was no significant difference between the two groups in terms of major complication or pancreatic fistular after operations (p = 0.20 and p = 0.71, respectively). For planned spleen-preserving operations, the RDP group had a shorter mean operative time (147 min vs. 194 min, p = 0.015) and a reduced total length of hospital stay compared with the LDP group (4 days vs. 7 days, p = 0.0002). The failure rate for spleen preservation was 0% in RDP and 20% (n = 5/25) in the LDP group (p = 0.009). RDP offered a better method for splenic preservation with Kimura’s technique compared with LDP to avoid the risk of splenic infarction and gastric varices related to ligation and division of splenic pedicles. RDP should be the standard operation for the resection of pancreatic tumours at the body and tail of the pancreas without involving the celiac axis or common hepatic artery. Full article
(This article belongs to the Special Issue Recent Updates on Surgical Treatment of Pancreaticobiliary Cancers)
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