New PhD on Laparoscopic surgery in the treatment of ductal adenocarcinoma in the distal pancreas: Surgical and oncological considerations

Dr Mushegh SahakyanOn December 14th 2017 surgeon Mushegh Shakyan at The Intervention Centre and Institute of Clinical Medicine at Faculty of Medicine, University of Oslo defended his thesis on Laparoscopic surgery in the treatment of ductal adenocarcinoma in the distal pancreas: Surgical and oncological considerations. Title of the trial lecture was "The role of surgery and chemotherapy in treatment of locally advanced pancreatic cancer". First opponent was associate professor Bergthor Björnsson from Linköpings University, Sweden, second opponent was professor Mustapha Adham from Edouard Herriot Hsopital, France. Main superviser was professor Bjørn Edwin. Abstract: Surgery is the cornerstone in the treatment of ductal adenocarcinoma in the body/tail of the pancreas. While open distal pancreatectomy is considered as a standard procedure in this setting, data on laparoscopic resections is scarce and limited to few reports.
This thesis aimed to investigate the role of laparoscopic distal pancreatectomy in the management of ductal adenocarcinoma. Surgical and oncologic outcomes, as well as factors related to patient selection, extent of surgery and prognosis were examined in the single- and multicentre studies. Hospital records and prospectively collected databases were reviewed.

Laparoscopic distal pancreatectomy was associated with conversion rate of <3%, and postoperative morbidity of 32% in patients with ductal adenocarcinoma. Despite the higher prevalence of comorbidities, elderly patients benefitted from laparoscopy and demonstrated survival rates similar to those in younger patients.
Perioperative and short-term oncologic results were comparable after standard and extended laparoscopic distal pancreatectomy (defined by the International Study Group for Pancreatic Surgery). The lymph node yield following surgery was found to depend on pathology examination - the use of a standardized pathology work-up markedly increased the lymph node yield and reduced the risk of understaging without changing surgical technique. Standard laparoscopic distal pancreatectomy was associated with lower recurrence rate (37 vs 64%) and longer median survival (33.3 vs 20.2) compared to the extended resection. No adjuvant chemotherapy, tumor size > 3cm and lymphovascular invasion were the risk factors for poor prognosis after standard resection.
Overall, laparoscopic distal pancreatectomy is appropriate in patients with ductal adenocarcinoma and is associated with oncologic outcomes comparable to those of open surgery. The next step is to test its benefits in a randomized setting.

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