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Outcomes After Minimally-Invasive Versus Open Pancreatoduodenectomy

 

 

 

The following summary comes from the Annals of Surgery, a leading source of peer-reviewed surgical literature. Original article can be found here.

Outcomes after minimally-invasive versus open pancreatoduodenectomy.

Klompmaker, S., van Hilst, J., Wellner, U.F. et al.

Annals of Surgery, June 2018

The Dutch Pancreatic Cancer Group is a coalition of medical centers in the Netherlands that collaborate and share data to improve the overall quality of care of pancreatic disease. In 2018, this group lead a collaboration of 14 experienced medical centers in Europe to determine the outcomes in patients undergoing Whipple operations with either an open approach or a minimally invasive approach (i.e. laparoscopic or robotic). In this study, patients were matched by similarity to eliminate selection bias. A total of 1,458 patients were included (729 open and 729 minimally invasive).

This study found that there were no differences in the following:
– major postoperative complications
– postoperative mortality
– need for post-operative drain placements
– need for re-operations
– length of hospital stay

Significant differences were found in:
Postoperative pancreatic fistula (leaking fluid from the pancreas where it is reconnected to the small intestine). The authors suggest this may be due to the learning curve associated with this part of the operation. This complication was higher in the minimally invasive group, but no differences were found between laparoscopic vs. robotic.

Additionally, laparoscopic approaches were more likely to be converted to an open procedure as compared to robotic approaches.

In summary, minimally invasive approaches are appropriate choices for the right patients when performed at experienced medical centers. Proper patient selection is the product of multiple factors and should be discussed between the patient and their medical team. As more centers gain experience with minimally invasive surgery, these procedures will most likely become safer and available at more medical centers.

Summary written by Michael Wright

Department of Surgery, Johns Hopkins School of Medicine.

Light scattering spectroscopy helps doctors identify early pancreatic cancer

Image from WebMD

Image from WebMD

Pancreatic cancer has the lowest survival rate among all major cancers, largely because physicians lack diagnostic tools to detect the disease in its early, treatable stages. Now, a team of investigators led by Lev T. Perelman, PhD, Director of the Center for Advanced Biomedical Imaging and Photonics at Beth Israel Deaconess Medical Center (BIDMC), has developed a promising new tool capable of distinguishing between harmless pancreatic cysts and those with malignant potential with an overall accuracy of 95 percent. The team’s preliminary data was published online in the journal Nature Biomedical Engineering.

The new device uses light scattering spectroscopy (LSS) to detect the structural changes that occur in cancerous or pre-cancerous cells by bouncing light off tissues and analyzing the reflected spectrum. The results could help guide physicians’ decision making when considering whether the presence of pancreatic cysts requires surgery, a high-risk procedure. Today, because of the lack of less-invasive diagnostic methods, more than half of these procedures turn out to have been unnecessary.

“About one-fifth of pancreatic cancers develop from cysts, but not all lesions are cancerous,” said Perelman, who is also Professor of Medicine and Professor of Obstetrics, Gynecology and Reproductive Biology at Harvard Medical School. “Considering the high risk of pancreatic surgeries and the even higher mortality from untreated pancreatic cancers, there’s an obvious need for new diagnostic methods to accurately identify the pancreatic cysts that need surgical intervention and those that do not.”

In Perelman and colleagues’ series of experiments, the LSS technique achieved 95 percent accuracy for identifying malignancy. Cytology — the only pre-operative test currently availably — is accurate only 58 percent of the time. While the new technique requires further testing, LSS could represent a major advance against pancreatic cancer.

“This tool is a technology that is transformative in the evaluation of pancreatic cysts,” said co-lead author Douglas K. Pleskow, MD, Clinical Chief of the Division of Gastroenterology and Director of the Colon and Rectal Cancer Program at the Cancer Center at BIDMC. “It provides a high level of precision in the detection of potential malignant transformation of these cysts.”

Pancreatic cysts are common, and today’s high-definition scanning technologies like MRI and CT imaging are detecting them with increasing frequency. Despite their high resolution, these scanners provide doctors with limited information about cysts’ malignant potential.

Currently, physicians rely on minimally-invasive fine needle aspiration (FNA) biopsies to test pancreatic cysts for malignancy. The biopsy removes fluid from the cysts, which is then analyzed for cancer cells and other telltale signs of the disease, a process called cytology. However, the test fails to detect cancer about half the time, leaving high-risk surgery as the current gold-standard means of diagnosing pancreatic cysts.

To test the accuracy of the LSS system, Perelman and colleagues collected and analyzed the reflected light from 13 cysts taken from recent surgeries. Next, they compared their findings with the results from pre-operative imaging, FNA biopsies and post-operative tissues analysis. In all cases, the LSS diagnosis agreed with the post-operative analysis.

In a second experiment, the LSS tool was tested in 14 patients with pancreatic cysts who were undergoing the standard FNA biopsy. Measuring less than half a millimeter in diameter, the miniature experimental LSS fiber-optic probe was inserted in the FNA needle. Physicians spent two minutes or less measuring optical spectra from the internal cyst surface before collecting fluid from the cysts as part of the traditional biopsy. Out of nine patients whose cysts had been definitely diagnosed as either cancerous or benign, all were correctly identified by LSS.

Next, the researchers will assess the LSS system’s accuracy by continuing to analyze post-operative tissues as they become available.

Article from Science Daily, Story source: Beth Israel Deaconess Medical Center