Pancreatic cancer is known for its very poor overall survival and only 1 in 5 of patients are eligible for surgeries with curative intent. In the past decades, a minimally invasive approach towards pancreatic resection has become an increasingly popular treatment. However, concerns remain present since a recent European survey demonstrated that 1 in 3 participating surgeons were uncertain about the oncological outcomes after performing minimally invasive pancreatic surgeries.

A international clinical study has been initiated with the acronym DIPLOMA: distal pa​ncreatectomy, minimally invasive or open, for malignancy. The trial aims to evaluate the safety and effectiveness of pancreatic cancer treatment with minimally invasive or open pancreatic surgery. In a previous trial, important short-term benefits for pancreatic cancer patients undergoing minimally invasive surgery were demonstrated. In comparison to open surgery, minimally invasive treatment resulted in shorter hospital stays and faster functional recovery, improving the immediate quality of life for these patients.

During the DIPLOMA trial, minimally invasive versus open surgery against pancreatic cancers will be assessed by documenting the extent of surgically removed pancreatic tissue and the number of lymph nodes retrieved during surgery. In addition, other surgery-related features such as duration of the operation, patient’s blood loss, and possible treatment conversion from minimally invasive to open surgery are recorded. The outcomes after surgery are documented as well, and encompass potential complications following the treatment, duration of hospitalization, quality of life and survival.

The DIPLOMA trail aims to recruit a total of 258 patients. These patients will be randomly assigned to either receive minimal invasive or open pancreatic surgery. Enrollment of patients into the clinical trial has started in May 2018 and is expected to be completed by the spring of 2021. Currently, 190 patients from 31 centers in The Netherlands, United Kingdom, United States, Italy, Norway, Finland, Slovenia, Spain, Germany, Sweden, France and Russia are participating (November 2020). The consortium is aiming to make the outcomes of the DIPLOMA trial publicly available during the summer 2021.

More information about the DIPLOMA trial and the European Consortium on Minimally Invasive Pancreatic Surgery can be found at

Researchers involved

Mohammed Abu Hilal