Short summary

Project 1 evaluates the resection margin width that holds prognostic value for overall survival in all patients who underwent pancreatic cancer (PC) surgery between 2015-2018 in Denmark. Project 2 evaluates the incidence and prognostic value of molecular biomarkers in blood and peritoneal lavage fluid (PLF) in patients undergoing PC surgery. Project 2A evaluates the most useful molecular biomarkers in PLF. In project 2B, the identified biomarker will be applied to the entire study grou

Rationale

Pancreatic cancer (PC) is a devastating disease for which surgical resection is the only hope for cure. However, even after microscopically radical resection (R0) the majority of patients will have recurrent disease, many of whom will die. The discrepancy between pathological assessment and clinical outcome indicates a frequent underestimation of microscopic margin (RM) involvement (R1), probably because the exact minimum margin width that holds prognostic value in PC is unknown. This further suggests that PC patients may harbour non-detected free cancer cells in blood and peritoneum (FITC) at the time of resection. New techniques, such as molecular biomarkers in blood and peritoneal lavage fluid (PLF), are needed to be able to identify those patients at risk of early recurrence after surgery.

This 2-tiered project aims to take an important step in this direction by

1) defining the margin width that holds prognostic value after PC surgery in a nationwide population-based cohort and by

2) evaluating pre- and postoperative incidence and prognostic implication of detection of molecular biomarkers for free tumor cells in peritoneal lavage fluid (PLF) and peripheral blood in PC.

The latter project will consist of a feasibility study (n=20) aiming at finding the most useful biomarker for FTCs in PLF. This biomarker will afterwards be applied in the main project 2 (including an additional 60 patients).

Description of the cohort

Project 1: All patients undergoing surgery for pancreatic ductal adenocarcinoma in Denmark between January 2015-December 2018.

Project 2: Patients undergoing surgery for pancreatic ductal adenocarcinoma in Danish (Odense University Hospital and Århus University Hospital), Swedish (Karolinska University Hospital) and German (University Medical Center Schleswig-Holstein, Campus Lübeck and Halle-Wittenberg University Hospital) tertiary centers.

Data from medical records and results of molecular analyses are registered in a REDCap database.

Data and biological material

Project 1 is based on data retrieved from the Danish Pancreatic Cancer Database undergoing surgery for pancreatic cancer between January 2015- December 2018.

Project 2 is based on material from the patient journal. Additionally, we perform molecular analyses on blood samples, peritoneal lavage fluid and material from primary tumor.

Collaborating researchers and departments

Department of Surgery, Odense University Hospital, Denmark

• Professor Michael Bau Mortensen
• Senior consultant, ph.d. Claus Wilki Fristrup

Department of Oncology, Odense University Hospital

• Professor Per Pfeiffer

Department of Surgery, Århus University Hospital

• Professor Frank Viborg Mortensen

Department of Surgery, Karolinska University hospital, Stockholm

• Senior consultant, ph.d. Ernesto Sparrelid

Department of Surgery, University Medical Center Schleswig-Holstein, Campus Lübeck, Germany

• Professor Tobias Keck

Department of Surgery, Halle-Wittenberg University Hospital, Germany

• Professor Jörg Kleeff