Clinical research

 

 

Surgeons at the Verona Pancreas Institute are recognized as leaders in clinical investigations in pancreatic diseases. Clinical research contributes to advances in the understanding prevention, diagnosis and treatment of pancreatic neoplasms and pancreatitis. Important research topic that are actively investigated include cystic and neuroendocrine neoplasms, pancreatic ductal adenocarcinoma, technologic advancements in pancreatic surgery and surgical morbidity after pancreatectomy. Read below to explore our clinical research projects.

 

Pancreatic cystic neoplasms

Pancreatic cystic neoplasms are a heterogeneous group of lesions with a wide spectum of biologic behavior, ranging from benign to overtly malignant. These neoplasms are being increasingly diagnosed due to the widespread use of cross-sectional imaging. Their clinical management is still controversial, and it is the focus of intense research. For further information on cystic neoplasms click here. More than 3000 patients with pancreatic cystic neoplasms have been observed by our faculty. Our research is focused on the natural history of intraductal papillary mucinous neoplasms (IPMN), and on the safety of a radiologic surveillance protocol for IPMN involving only the branch ducts. Other research projects are investigating prospectively the association between the presence of a pancreatic cyst and abdominal symptoms, as well as the psychologic impact of the diagnosis of a pancreatic cyst and the subsequent surveillance process.

 

Pancreatic ductal adenocarcinoma

Pancreatic ductal adenocarcinoma (PDAC) is the commonest pancreatic neoplasm. It is a very aggressive disease, and represents the fourth leading cause of cancer death in the Western world. When feasible, surgical resection is the key step towards long-term survival. For further information on PDAC click here. More than 500 patients with PDAC are referred yearly to our surgeons, but only a minority is unfortunately suitable for a resection with radical intent. Current research projects are focused on the prognostic role of lymph node stations in distal pancreatectomy and pancreatoduodenectomy. Furthermore, research is focused on neoadjuvant therapy in resectable and borderline resectable disease. A phase II trial of neoadjuvant chemotherapy in resectable disease is enrolling patients (NAP-OX protocol, 5-FU, nanoliposomial irinotecan, oxaliplatin; study coordinator Prof. Davide Melisi, Unit of Oncology).

 

Pancreatic neuroendocrine neoplasms

Pancreatic neuroendocrine neoplasms are lesion arising from islet cells (hormone-making cells). These neoplasms are much less common than pancreatic exocrine tumors (incidence of 4-5 cases/100000), and have a better prognosis. However, their incidence is increasing. For further information on pancreatic neuroendocrine tumors click hereMore than 500 patients with neuroendocrine tumors have been operated on at the Unit of Pancreatic Surgery in Verona. Our clinical research is focused on the management of small, incidentally diagnosed non-functioning lesions, and on the role of minimally invasive techniques for the treatment of such neoplasms. 

 

Postoperative morbidity following pancreatectomy 

Pancreatic resections are associated with a substantial rate of postoperative complications, in the range of 30-50%. This results in prolonged hospital stay and increased utilization of economic resources. For further information about postoperative complications in pancreatic surgery click here. Our surgeons contributed significantly to the definition and the understanding of pancreatic fistula (the most relevant postoperative complication), and of other major complications, including post-pancreatectomy hemorrhage and delayed gastric emptying. Current research projects involve the prediction of pancreatic fistula and optimal mitigation strategies in distal pancreatectomy. In addition, three randomized controlled trials are underway: 

  • TRUDY trial, transection of pancreatic neck during distal pancreatectomy using reinforced stapler versus Harmonic scalpel;
  • PREP trial, Duct-to-mucosa pancreaticojejunostomy with external stent versus pancreaticogastrostomy with external stent in hih-risk pancreatic remnant (fistula risk score 7-10) following pancreatoduodenectomy;
  • Intraoperatove wound protection using ALEXIS retractor versus steridarape: impact on superficial surgical site infections.