Pancreatic surgery today involves a wide variety of surgical and non-surgical medical disciplines. Several aspects to improve the multidisciplinary management of patients undergoing pancreatic... Show morePancreatic surgery today involves a wide variety of surgical and non-surgical medical disciplines. Several aspects to improve the multidisciplinary management of patients undergoing pancreatic surgery were identified, implemented and used to design future studies. More than 15 medical disciplines were involved during the studies involved in this thesis. Highly needed further improvement of outcome of pancreatic patients can be made by multidisciplinary collaborations on a hospital, regional, national and international level. Show less
Jong, T.L. de; Koopman, D.; Worp, C.A.J. van der; Stevens, H.; Vuijk, F.A.; Vahrmeijer, A.L.; ... ; Patijn, G.A. 2023
Background: We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with... Show moreBackground: We studied the added value of digital FDG-PET/CT in disease staging and restaging compared to the standard work-up with contrast enhanced CT (ceCT) and CA19-9 in patients with resectable or borderline resectable pancreatic cancer who received neo-adjuvant therapy. Primary endpoints were tumor response compared to ceCT and CA19.9 as well as the ability to detect distant metastatic disease.Methods: 35 patients were included in this dual-center prospective study. FDG-PET using digital photon counting technology combined with CT scans were acquired before (T1) and after neo-adjuvant therapy (T2). Patients were staged and restaged based on standard protocol with ceCT and CA 19.9, while all PET/CT scans were stored securely and not included in clinical decision making. After the pancreatic resection, an expert team retro-spectively assessed the CT tumor diameter, CA19-9, tumor FDG-uptake, and appearance of metastatic disease of all patients for both time points.Results: CA19-9 levels, CT tumor diameter, and tumor FDG-uptake on PET significantly decreased from T1 to T2 (p = 0.017, p = 0.001, and p < 0.0001). The change in FDG-uptake values showed a strong positive correlation with the change in CT tumor diameter and change in CA19-9 (R = 0.75 and R = 0.73, respectively). In addition, small-volume liver lesions were detected on digital PET/CT in 5/35 patients (14%), 4 of which were pathology confirmed at laparotomy. Only one of these five cases was detected on baseline staging ceCT (3%). Conclusion: We found that adding digital PET/CT strengthens restaging after neo-adjuvant therapy based on the observed strong correlation with ceCT tumor diameter and Ca19.9. Also, digital PET/CT was found to detect occult metastatic disease not visualized on ceCT, that would have resulted in altered disease staging and ther-apeutic strategy in a substantial proportion of patients. Show less
