Improving outcomes of minimally invasive pancreas surgery and ampullary cancer

Ampullary adenocarcinoma is a rare tumor that arises from the ampulla of Vater; the confluence of the common bile duct and the pancreatic duct. It represent a heterogeneous group with considerable morphological heterogeneity and therefore, a broad range of survival rates. The only potential curative treatment is surgical resection through a pancreatoduodenectomy, a major procedure with high morbidity- and mortality rates. The role of adjuvant chemotherapy in ampullary adenocarcinoma is unclear. Given the rarity of ampullary adenocarcinomas, no single randomized clinical trial in adjuvant treatment has focused specifically on ampullary adenocarcinoma. The research in this thesis aims to improve the surgical aspect of the treatment, through minimally invasive pancreas surgery, with the focus on implementation and safety. Another pillar of this thesis is improving the prediction of survival after resection of ampullary adenocarcinomas by defining predictors of survival and recurrence as well as developing a prediction model to anticipate 3- and 5-year survival of individual patients. Lastly, the role of adjuvant chemotherapy in ampullary adenocarcinoma is investigated.