This dissertation of Bobby Pranger investigates the treatment and diagnostics of pancreatic cancer, with a particular focus on surgeries and imaging techniques.
Chapter 2 compares complications after pancreatic surgery in young and older patients. While complications occur equally often, young patients who undergo pancreatic head surgery are less likely to develop pancreatic function problems. Further research is needed to understand these differences.
Chapter 3 examines the accuracy of CT scans in detecting lymph node metastases around the aorta. CT scans are not always reliable, meaning that suspected metastases on a CT scan should not automatically prevent surgery.
Chapter 4 investigates the value of a chest CT scan before pancreatic surgery. A chest CT shows significant abnormalities in 10% of patients, including metastases in 4% of cases. Due to the risk of treatment delays, it is recommended to perform this scan simultaneously with the pancreatic CT scan.
In Chapter 5, the utility of a liver ultrasound during a laparoscopy is assessed. The ultrasound provides additional information in only 4% of cases, especially if a significant amount of time has passed since the last CT scan. Therefore, it is concluded that the ultrasound has little added value when recent imaging is available.
Chapter 6 analyzes the impact of lymph node metastases in stations 8a, 9, and 16b1 on survival. Metastases in station 16b1 lead to very poor survival. This study shows that the removal of station 16b1 lymph nodes during surgery may be justified in pancreatic and periampullary cancer.
Chapter 7 compares the outcomes of a pancreatoduodenectomy and a palliative double bypass in patients with metastases to station 16b1. While the pancreatoduodenectomy offers longer survival, it is associated with more complications.
Chapter 8 investigates the use of bevacizumab-800CW for detecting pancreatic cancer cells. Despite its safety, it proved challenging to reliably distinguish cancer cells from normal tissue, leading to an early termination of the study.
This dissertation has provided further evidence on current imaging techniques and the evaluation of lymph nodes and metastases during surgery. Additionally, this dissertation has offered valuable insights into fluorescence-guided surgery in pancreatic cancer.
