Minimally Invasive Surgery May Be a Good Option for Pancreatic Cancer Patients

Dennis Thompson HealthDay Reporter

(Health Day)

Friday, May 26, 2023 (Health Day News) — Minimally invasive surgery is as effective as full-scale open surgery in resecting early-stage pancreatic cancer, allowing patients to recover faster with reduced risk of infection A new clinical trial found that it could.

Dr. Mohammad Abu Hilal, Chief Surgeon and Principal Investigator at the Ospedaliello Institute of the Polyambranza Foundation in Brescia, Italy, said the ability to remove all cancer and the rate of cancer recurrence were essentially the same in the two groups. said it was.

“This trial, the first of its kind, confirms that minimally invasive distal pancreatic resection is a safe, effective and efficient alternative to invasive approaches in the treatment of resectable pancreatic cancer. We can,” Hilal said at a recent media briefing. According to the American Society of Clinical Oncology (ASCO). Hilal will announce the trial results at the ASCO Annual Meeting June 2-6 in Chicago.

Dr. Julie Gralow, ASCO’s chief medical officer, said these results “could change the standard of care, but could create a gap in the standard of care available to patients.”

“Where many rural and general surgeons in the United States perform such treatments may not yet be trained in minimally invasive approaches, this is comparable in terms of results and recovery. It’s shown to be better for patients in terms of time,” Gralow said.

Gralow and Hilal also acknowledged that less than 1 in 7 patients have this option because pancreatic cancer is often detected late.

“Unfortunately, only 15% of people with pancreatic cancer are diagnosed at the time they are eligible for surgery,” Grarow said. “Thus, we acknowledge upfront that most pancreatic cancer patients are not resectable. [able to have their cancers removed by surgery] when we diagnose them. ”

According to ASCO, the five-year relative survival rate for early-stage pancreatic cancer that can be treated with surgery is 44%. About 64,000 adults in the United States are diagnosed with pancreatic cancer each year.

For the trial, Hilal and his colleagues screened more than 1,100 pancreatic cancer patients, 258 of whom were diagnosed with early-stage pancreatic cancer that could be surgically removed without first undergoing chemotherapy.

The trial will run from 2018 to 2021, with surgeries performed at 35 major medical centers in 12 countries.

Half of the patients were randomly assigned to undergo minimally invasive surgery to remove the pancreas and spleen through several small incisions. The other half underwent standard laparotomy using one large incision.

The results showed that surgeons were able to completely remove the tumor in 73% of the minimally invasive group compared to 69% of the open surgery group.

The mean number of lymph nodes removed during this procedure was also similar: 22 in the minimally invasive group versus 23 in the open surgery group. At least 13 lymph nodes are needed to make sure the cancer has not spread to other parts of the body, the researchers explained.

The rate of cancer recurrence in the pancreatic region was essentially the same between the two groups. 41% in minimally invasive patients compared to 38% in open surgery.

“The bottom line is that it requires additional training and technical skills, but recovery is remarkably quick,” Grarow said. “The patient is better off with a minimally invasive technique, and the ability to remove all of the tumor is comparable to the recurrence rate.”

These results should encourage greater use of minimally invasive surgery to treat patients who are lucky enough to find pancreatic cancer early, Hilal said.

“Randomized controlled trials are always the last step in convincing those who aren’t convinced or supporting those who are convinced to do so,” he added.

But right now, this option may not be available to everyone, Hilal and Gralow explained.

Surgeons in small hospitals often do not have the training or experience to perform minimally invasive surgery.

“Evidence shows that the best results are obtained in mass surgical centers where surgeons perform at least 50 pancreatic resections annually. It’s difficult,” Hilal said.

“Surgeons who do this need to be well trained in open surgery, but they also need to be well trained in minimally invasive surgery,” he continued. “Patients should be sent to specialized centers in this field.”

The researchers will continue to follow these patients and compare their condition three and five years after surgery.

Findings presented at medical conferences should be considered preliminary pending publication in a peer-reviewed journal.

Source: Dr. Mohammad Abu Hilal, Director of Surgery, Polyambranza Hospital, Brescia, Italy.Julie Gralow, M.D., Chief Medical Officer, American Society of Clinical Oncology

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