To honour Pancreatic Cancer Awareness Month, we’re highlighting some of the most important research published this year in BJS Journals, BJS and BJS Open, on #pancreaticcancer. Advancing research in this field is essential to improving patient outcomes and offering hope. Together, we can make a difference.
In recognition of Pancreatic Cancer Awareness Month, the BJS highlights the following four recent studies:
This systematic review included 5 studies with 863 patients and reveals that 1 in 5 patients with localised pancreatic cancer switched chemotherapy due to stable disease, CA19-9 changes, or toxicity. The resection rate post-switch was 42%, with similar overall survival compared to those staying on first-line therapy.
New findings from the multicentre DIPLOMA trial challenge the routine use of splenectomy in left-sided pancreatectomy for PDAC. Among 185 patients, splenic lymph node metastases (LN+) were detected in just 2.2% of cases, with an even lower rate of 0.8% for pancreatic body cancers. While splenectomy aims to improve lymph node clearance, the rarity of splenic LN+ raises concerns about its necessity, especially given risks like severe post-splenectomy sepsis. These results call for further research into spleen-preserving approaches.
This study found that adjuvant chemotherapy did not affect recurrence rates, patterns, or survival in patients with adenocarcinoma from IPMN. Despite its established role in PDAC, the benefits for IPMN-related adenocarcinoma remain unclear, with evidence mainly from small studies and databases. Some data suggest survival benefits in node-positive or advanced-stage disease, but findings are limited by inconsistencies in staging and treatment protocols. Further research is needed to clarify its role.
This study included 663 LAPC patients treated with (m)FOLFIRINOX, and found that 28.2% of surgical explorations resulted in non-therapeutic laparotomies, nearly half due to occult metastases. Despite a 3% 90-day mortality rate, these patients had outcomes similar to non-surgical cases in terms of further chemotherapy and overall survival.
BJS Open highlights the following three recent pivotal studies advancing our understanding and management of pancreatic cancer:
This study investigated the role of surgical approaches during pancreatoduodenectomy—comparing the no-touch and superior mesenteric artery approaches—on the mobilization of circulating tumour cells (CTCs) and clusters in patients with periampullary tumours. While no significant differences in CTC mobilization or survival outcomes were observed between the two techniques, high intraoperative cluster dissemination correlated with early metastases in pancreatic ductal adenocarcinoma patients. These findings emphasize the potential role of cluster mobilization as a biomarker for early metastatic risk.
A meta-analysis of randomized trials assessed the long-term overall survival impact of neoadjuvant treatment compared to upfront surgery in patients with resectable PDAC. While neoadjuvant treatment demonstrated no significant survival advantage over upfront surgery, this study underscores the need for personalized approaches to preoperative therapy in resectable PDAC.
A multicentre study evaluated the influence of postoperative pancreatic fistula (POPF) on survival outcomes after pancreatoduodenectomy for PDAC. POPF, including grade C fistula, did not adversely affect recurrence-free or overall survival.
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