Expanding eligibility and improving patient outcomes for pancreatic surgery

This PhD thesis incorporates several studies into surgical selection, technique refinement, and optimization of outcomes for three important pancreatic surgery procedures; minimally invasive pancreatoduodenectomy (PD), minimally invasive distal pancreatectomy (DP), and distal pancreatectomy with celiac axis resection (DP-CAR).
The first part describes six international studies on improving patient outcomes by minimizing the negative physiological impact (i.e. the invasiveness) of partial pancreatectomy through minimally invasive (laparoscopic or robot-assisted) techniques. The thesis concludes that minimally invasive DP, compared to open DP, leads to a two-day reduction in length of hospital stay and a 12% reduction in severe postoperative complications. Conversely, it found no apparent benefit for minimally invasive PD and concludes that this approach needs to improved and studied further before its added value can be established.
The second part describes the revival of the DP-CAR for treatment of locally advanced pancreatic cancer, otherwise unresectable, in order to let more patients undergo pancreatic surgery. Based on four international studies, the thesis concludes that DP-CAR after FOLFIRINOX chemotherapy leads to acceptable survival and complication rates, when performed on carefully selected patients at high-volume pancreas centers.