Oncological outcomes in pancreatic cancer similar with less-invasive vs open surgery

In patients with upfront resectable pancreatic cancer, minimally invasive left pancreatectomy (MILP) and   open left pancreatectomy (OLP) appear to result in similar oncological outcomes, as shown in the DIPLOMA trial.

DIPLOMA included 258 patients with upfront resectable left-sided pancreatic ductal adenocarcinoma of the body or tail of the pancreas, recruited at 35 centres across 12 countries. These patients were randomly assigned to undergo MILP (laparoscopic and robotic, n=131) or OLP (n=127).

The primary outcomes were overall survival (OS) and disease-free survival (DFS). Other outcomes included receipt of adjuvant therapy and time to start of adjuvant therapy.

Over a median follow-up of 38 months, 134 patients (52 percent) had died and 127 patients (55 percent) experienced disease recurrence. Median OS was similar between the MILP and OLP groups, at 32 vs 34 months, respectively (stratified hazard ratio [HR], 1.02, 95 percent confidence interval [CI], 0.72–1.44; p=0.92).

Median DFS was also comparable between the MILP and OLP groups, at 21 vs 17 months, respectively (stratified HR, 0.96, 95 percent CI, 0.68–1.35; p=0.81).

Adjuvant therapy was given to 79 patients after MILP and to 79 patients after OLP (70 percent vs 72 percent; p=0.63). Median time to adjuvant therapy did not significantly differ between the two groups (59 vs 56 days, respectively; p=0.92).