DIPLOMA Trial: Minimally Invasive Surgery is an Effective Treatment Option for Early-Stage Pancreatic Cancer

July 18, 2023

A notable study, DIPLOMA, led by Abu Hilal, M.D., Ph.D., of the Istituto Ospedaliero Fondazione Poliambulanza in Brescia, Italy, involved a large cohort of 258 patients with fully resectable (operable), early-stage pancreatic cancer who underwent laparoscopic distal pancreatectomy (is the removal of the end of the pancreas while leaving the pancreatic head attached) with splenectomy (surgical removal of the spleen). The international phase III DIPLOMA trial is the first randomised, patient-blinded study comparing open surgery versus minimally invasive surgery when tumours are present on the body or tail of the pancreas. The results of the DIPLOMA study presented at the 2023 American Society of Clinical Oncology (ASCO) (abstract 4163) showed comparable oncological outcomes, including overall survival and disease-free survival, similar to open surgery. There were no significant differences between intraperitoneal recurrence and intraoperative severe adverse events such as bleeding or injuries to other organs. Furthermore, the laparoscopic approach offered advantages such as reduced blood loss, shorter hospital stays, and faster recovery times.

These findings support using minimally invasive surgical techniques as an effective and safe treatment option for pancreatic cancer, offering oncological efficacy and improved post-operative outcomes. However, it is essential to note that the procedure’s suitability should be evaluated on a case-by-case basis, considering factors such as tumour characteristics and the patient’s overall health. A comprehensive assessment by a multidisciplinary team of health professionals is essential in determining the most appropriate treatment approach for individual patients.

Dr. Abu Hilal also emphasised that “the best results are obtained in high-volume centres where surgeons do more than at least 50 pancreatic resections a year” because the minimally invasive approach is “quite complex and difficult” compared to open surgery.

This clinical trial confirms that minimally invasive pancreatectomy is a safe, valid, and efficient alternative” to open surgery for early-stage cancers in the body and tail of the pancreas.

Long-term follow-up studies and comparative trials are crucial in improving surgical techniques and patient outcomes. Researchers will continue to follow these patients, intending to compare results at three and five years after their surgery. They will also do additional trials to compare outcomes between the laparoscopic and robotic minimally invasive surgical techniques.


J. van Hilst et. al., Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): An international randomised trial, Trials. 2021; 22: 608, doi: 10.1186/s13063-021-05506-z

M. Abu Hilal, et al., Minimally invasive versus open distal pancreatectomy for resectable pancreatic cancer (DIPLOMA): An international randomised trial, Journal of Clinical Oncology. 2023; 41:16, 4163-4163.

Ana Martins

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