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Cancers
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Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma
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Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma

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

Deadline for manuscript submissions: closed (28 February 2025) | Viewed by 6272

Special Issue Editor

Dr. Shuji Isaji

E-Mail Website
Guest Editor
1. Department of Hepato-Biliary-Pancreatic and Transplant Surgery, Mie University, Tsu 514-0102, Mie, Japan
2. Matsusaka City Hospital, Matsusaka-shi 515-8544, Mie, Japan
Interests: pancreatic cancer; surgical treatment; chemoradiotherapy
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

With recent advances in neoadjuvant and adjuvant treatment modalities for pancreatic ductal carcinoma (PDAC), the outcomes of pancreatic surgery have improved. Additionally, there has been notable progress in surgical techniques after neoadjuvant therapy, such as the aggressive combined resection of major vessels, arterial divestment and the introduction of laparoscopic or robotic surgery.

The focus of this Special Issue is to consider the following research aspects of PDAC (original or review article): (a) resectability classification, (b) PDAC management according to the resectability classification, (c) the indication of conversion surgery and its outcome, (d) novel surgical techniques used for the combined resection of portal veins and major arteries, and (e) the indication of laparoscopic and robotic surgeries.

Dr. Shuji Isaji
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 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

  • neoadjuvant therapy
  • adjuvant therapy
  • resectability
  • conversion surgery
  • surgical technique
  • laparoscopic surgery
  • robotic surgery

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Published Papers (4 papers)

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Research

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10 pages, 641 KiB  
Article
Robotic Pancreaticoduodenectomy for Pancreatic Head Tumour: A Single-Centre Analysis
by Vera Hartman, Bart Bracke, Thiery Chapelle, Bart Hendrikx, Ellen Liekens and Geert Roeyen
Cancers 2024, 16(24), 4243; https://doi.org/10.3390/cancers16244243 - 20 Dec 2024
Cited by 1 | Viewed by 865
Abstract
Background: The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases’ short-term and oncological outcomes to a historical cohort of open cases. Methods: Data were collected in a prospective database between 2016 and 2024; complications [...] Read more.
Background: The robotic approach is an appealing way to perform minimally invasive pancreaticoduodenectomy. We compare robotic cases’ short-term and oncological outcomes to a historical cohort of open cases. Methods: Data were collected in a prospective database between 2016 and 2024; complications were graded using the ISGPS definition for the specific pancreas-related complications and the Clavien–Dindo classification for overall complications. Furthermore, the Comprehensive Complication Index was calculated. All patients undergoing pancreaticoduodenectomy were included, except those with acute or chronic pancreatitis, vascular tumour involvement or multi-visceral resections. Only the subset of patients with malignancy was regarded for the oncologic outcome. Results: In total, 100 robotic and 102 open pancreaticoduodenectomy cases are included. Equal proportions of patients have a main pancreatic duct ≤3 mm (p = 1.00) and soft consistency of the pancreatic remnant (p = 0.78). Surgical time is longer for robotic pancreaticoduodenectomy (p < 0.01), and more patients have delayed gastric emptying (44% and 28.4%, p = 0.03). In the robotic group, the number of patients without any postoperative complications is higher (p = 0.02), and there is less chyle leak (p < 0.01). Ninety-day mortality, postoperative pancreatic fistula, and postpancreatectomy haemorrhage are similar. The lymph node retrieval and R0 resection rates are comparable. Conclusions: In conclusion, after robotic pancreaticoduodenectomy, remembering all cases during the learning curve are included, less chyle leak is observed, the proportion of patients without any complication is significantly larger, the surgical duration is longer, and more patients have delayed gastric emptying. Oncological results, i.e., lymph node yield and R0 resection rate, are comparable to open pancreaticoduodenectomy. Full article
(This article belongs to the Special Issue Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma)
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12 pages, 581 KiB  
Article
Distal Pancreatectomy with and without Celiac Axis Resection for Adenocarcinoma: A Comparison in the Era of Neoadjuvant Therapy
by Sara K. Daniel, Camille E. Hironaka, M. Usman Ahmad, Daniel Delitto, Monica M. Dua, Byrne Lee, Jeffrey A. Norton, Brendan C. Visser and George A. Poultsides
Cancers 2024, 16(20), 3467; https://doi.org/10.3390/cancers16203467 - 12 Oct 2024
Viewed by 1479
Abstract
Background: Distal pancreatectomy with celiac axis resection (DP-CAR) has been used for selected patients with pancreatic cancer infiltrating the celiac axis. We compared the short- and long-term outcomes between DP-CAR and distal pancreatectomy alone (DP) in patients receiving neoadjuvant therapy. Methods: Patients undergoing [...] Read more.
Background: Distal pancreatectomy with celiac axis resection (DP-CAR) has been used for selected patients with pancreatic cancer infiltrating the celiac axis. We compared the short- and long-term outcomes between DP-CAR and distal pancreatectomy alone (DP) in patients receiving neoadjuvant therapy. Methods: Patients undergoing DP-CAR from 2013 to 2022 were retrospectively reviewed. Clinicopathologic features, post-operative morbidity, and survival outcomes were compared with patients undergoing DP after neoadjuvant chemotherapy. Results: Twenty-two DP-CAR and thirty-four DP patients who underwent neoadjuvant chemotherapy were identified. There were no differences in comorbidities or CA19-9 levels. OR time was longer for DP-CAR (304 vs. 240 min, p = 0.007), but there was no difference in the transfusion rate (22.7% vs. 14.7%). Vascular reconstruction was more common in DP-CAR (18.2% vs. 0% arterial, p = 0.05; 40.9% vs. 12.5% venous, p = 0.04). There was no difference in morbidity or mortality between the two groups. Although there was a trend towards larger tumors in DP-CAR (5.1 cm vs. 3.8 cm, p = 0.057), the overall survival from the initiation of treatment (32 vs. 28 months, p = 0.43) and surgery (30 vs. 24 months, p = 0.43) were similar. Discussion: DP-CAR is associated with similar survival and morbidity compared to DP patients requiring neoadjuvant chemotherapy and should be pursued in appropriately selected patients. Full article
(This article belongs to the Special Issue Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma)
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11 pages, 651 KiB  
Article
Different Periampullary Types and Subtypes Leading to Different Perioperative Outcomes of Pancreatoduodenectomy: Reality and Not a Myth; An International Multicenter Cohort Study
by Bas A. Uijterwijk, Daniël H. Lemmers, Giuseppe Kito Fusai, Bas Groot Koerkamp, Sharnice Koek, Alessandro Zerbi, Ernesto Sparrelid, Ugo Boggi, Misha Luyer, Benedetto Ielpo, Roberto Salvia, Brian K. P. Goh, Geert Kazemier, Bergthor Björnsson, Mario Serradilla-Martín, Michele Mazzola, Vasileios K. Mavroeidis, Santiago Sánchez-Cabús, Patrick Pessaux, Steven White, Adnan Alseidi, Raffaele Dalla Valle, Dimitris Korkolis, Louisa R. Bolm, Zahir Soonawalla, Keith J. Roberts, Miljana Vladimirov, Alessandro Mazzotta, Jorg Kleeff, Miguel Angel Suarez Muñoz, Marc G. Besselink and Mohammed Abu Hilaladd Show full author list remove Hide full author list
Cancers 2024, 16(5), 899; https://doi.org/10.3390/cancers16050899 - 23 Feb 2024
Cited by 5 | Viewed by 2935
Abstract
This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major [...] Read more.
This international multicenter cohort study included 30 centers. Patients with duodenal adenocarcinoma (DAC), intestinal-type (AmpIT) and pancreatobiliary-type (AmpPB) ampullary adenocarcinoma, distal cholangiocarcinoma (dCCA), and pancreatic ductal adenocarcinoma (PDAC) were included. The primary outcome was 30-day or in-hospital mortality, and secondary outcomes were major morbidity (Clavien-Dindo 3b≥), clinically relevant post-operative pancreatic fistula (CR-POPF), and length of hospital stay (LOS). Results: Overall, 3622 patients were included in the study (370 DAC, 811 AmpIT, 895 AmpPB, 1083 dCCA, and 463 PDAC). Mortality rates were comparable between DAC, AmpIT, AmpPB, and dCCA (ranging from 3.7% to 5.9%), while lower for PDAC (1.5%, p = 0.013). Major morbidity rate was the lowest in PDAC (4.4%) and the highest for DAC (19.9%, p < 0.001). The highest rates of CR-POPF were observed in DAC (27.3%), AmpIT (25.5%), and dCCA (27.6%), which were significantly higher compared to AmpPB (18.5%, p = 0.001) and PDAC (8.3%, p < 0.001). The shortest LOS was found in PDAC (11 d vs. 14–15 d, p < 0.001). Discussion: In conclusion, this study shows significant variations in perioperative mortality, post-operative complications, and hospital stay among different periampullary cancers, and between the ampullary subtypes. Further research should assess the biological characteristics and tissue reactions associated with each type of periampullary cancer, including subtypes, in order to improve patient management and personalized treatment. Full article
(This article belongs to the Special Issue Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma)
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Review

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14 pages, 1346 KiB  
Review
Arterial Resections in Pancreatic Cancer—An Updated Systematic Review and Meta-Analysis
by Colin Noel, Adeboye Azeez, Annamarie Du Preez and Kiera Noel
Cancers 2025, 17(9), 1540; https://doi.org/10.3390/cancers17091540 - 1 May 2025
Viewed by 210
Abstract
Complete oncological resection of pancreatic cancer remains the cornerstone in treatment of pancreatic cancer. Anatomical relations to major vessels continue to play an ongoing important role in the decision-making regarding treatment options in pancreatic cancer. Despite concomitant venous resections being routinely performed in [...] Read more.
Complete oncological resection of pancreatic cancer remains the cornerstone in treatment of pancreatic cancer. Anatomical relations to major vessels continue to play an ongoing important role in the decision-making regarding treatment options in pancreatic cancer. Despite concomitant venous resections being routinely performed in major centers, arterial resections remain controversial. The aim of this study was to compare the short- and long-term outcomes of pancreatic cancer surgery with concomitant arterial resections to standard non-arterial resections from modern studies. We included studies comparing pancreatic cancer surgery with arterial resections to standard non-arterial surgery for pancreatic cancer published from 2018 to 2024. A total of seven articles involving 5465 patients met the inclusion criteria and were included for analysis. Arterial resections are associated with a greater risk of mortality compared to standard resections (Risk ratio (RR): 3.28; 95% confidence interval (CI) [0.75–14.46]; p = 0.0365). There were no significant differences in overall morbidity (RR: 1.48; 95% CI [1.16–1.89]; p = 0.2923) or serious complications (Mean Difference (MD): 2.6; 95% CI: [−21.52–16.32]; p = 0.738). Arterial resections were associated with a 3.1-fold increased chance of R0 resection (RR: 3.11; 95% CI [1.65–5.86]; p < 0.0227). Arterial resection in pancreatic cancer continues to be associated with an increased risk of mortality; however, recent studies show no significant increase in morbidity whilst significantly increasing R0 resections. Full article
(This article belongs to the Special Issue Recent Advances in Pancreatic Surgery for Pancreatic Ductal Adenocarcinoma)
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