{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,16]],"date-time":"2026-10-16T21:46:01Z","timestamp":1792187161323,"version":"4.4.0"},"reference-count":28,"publisher":"American Medical Association (AMA)","issue":"12","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2025,12,1]]},"abstract":"<jats:sec>\n                    <jats:title>Importance<\/jats:title>\n                    <jats:p>The DIPLOMA trial showed comparable radical resection rates after minimally invasive left pancreatectomy (MILP) and open left pancreatectomy (OLP) in patients with upfront resectable pancreatic cancer. Data on long-term overall survival (OS) and disease-free survival (DFS) are currently lacking, but are required before the oncological efficacy of MILP can be confirmed.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Objective<\/jats:title>\n                    <jats:p>To determine the long-term oncological outcome, including OS and DFS, of MILP vs OLP in patients with upfront resectable left-sided pancreatic cancer in the DIPLOMA trial.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Design, Setting, and Participants<\/jats:title>\n                    <jats:p>The randomized, patient-blinded and pathologist-blinded DIPLOMA trial was conducted between 2018 and 2021, with a follow-up duration of at least 36 months. It was a multicenter international trial that took place in 35 centers in 12 countries worldwide. Patients with upfront resectable pancreatic ductal adenocarcinoma of the body or tail of the pancreas were included.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Interventions<\/jats:title>\n                    <jats:p>Participants were randomly assigned to undergo MILP (laparoscopic and robotic) or OLP. Patients were blinded for the surgical approach.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Main Outcomes and Measures<\/jats:title>\n                    <jats:p>Main outcomes included OS and DFS. Other outcomes include receipt of adjuvant therapy and time to start of adjuvant therapy.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Results<\/jats:title>\n                    <jats:p>\n                      Between May 2018 and May 2021, 258 patients were randomized to the MILP (131 patients) and OLP (127 patients) groups. After a median follow-up of 38 (IQR 36-46) months, 134 patients (52%) had died and 127 patients (55%) experienced disease recurrence. OS did not differ significantly between the MILP and OLP groups (median, 32 vs 34 months; stratified hazard ratio, 1.02; 95% CI, 0.72-1.44;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.92). Also, DFS did not significantly differ between the MILP and OLP groups (median, 21 vs 17 months; stratified hazard ratio, 0.96; 95% CI, 0.68-1.35;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.81). Adjuvant therapy was administered in 79 patients after MILP (79 of 113 [70%]) and 79 patients after OLP (79 of 110 [72%]) (\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.63). Time to adjuvant therapy was comparable between groups (median 59 vs 56 days;\n                      <jats:italic>P<\/jats:italic>\n                      \u2009=\u2009.92).\n                    <\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Conclusions and Relevance<\/jats:title>\n                    <jats:p>In this long-term follow-up of the randomized DIPLOMA trial in patients with upfront resectable pancreatic cancer, oncological outcomes after MILP and OLP did not differ significantly, confirming the oncological safety of MILP.<\/jats:p>\n                  <\/jats:sec>\n                  <jats:sec>\n                    <jats:title>Trial Registration<\/jats:title>\n                    <jats:p>\n                      International Standard Registered Clinical\/Social Study Number Registry Identifier:\n                      <jats:ext-link xmlns:xlink=\"http:\/\/www.w3.org\/1999\/xlink\" ext-link-type=\"uri\" xlink:href=\"https:\/\/www.isrctn.com\/ISRCTN44897265\">ISRCTN44897265<\/jats:ext-link>\n                    <\/jats:p>\n                  <\/jats:sec>","DOI":"10.1001\/jamasurg.2025.4054","type":"journal-article","created":{"date-parts":[[2025,10,8]],"date-time":"2025-10-08T15:00:59Z","timestamp":1759935659000},"page":"1299","source":"Crossref","is-referenced-by-count":14,"title":["Minimally Invasive vs Open Left Pancreatectomy for Resectable Pancreatic Cancer"],"prefix":"10.1001","volume":"160","author":[{"given":"Caro L.","family":"Bruna","sequence":"first","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, the Netherlands"},{"name":"Department of General Surgery, Fondazione Poliambulanza Istituto Ospedaliero, Brescia, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Jony","family":"van Hilst","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, the Netherlands"},{"name":"Department of Surgery, OLVG Hospital, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Maarten","family":"Korrel","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Leia R.","family":"Jones","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Gianpaolo","family":"Balzano","sequence":"additional","affiliation":[{"name":"Department of Pancreatic and Transplant Surgery, San Raffaele Hospital IRCCS, Universit\u00e0 Vita-Salute, Milan, Italy"},{"name":"Department of Medicine and Technological Innovation (DIMIT), University of Insubria, Ospedale di Circolo, Varese, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bergthor","family":"Bj\u00f6rnsson","sequence":"additional","affiliation":[{"name":"Department of Surgery and Department of Biomedical and Clinical Sciences, Link\u00f6ping University, Link\u00f6ping, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ugo","family":"Boggi","sequence":"additional","affiliation":[{"name":"Department of Surgery, Universit\u00e1 di Pisa, Pisa, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Svein Olav","family":"Bratlie","sequence":"additional","affiliation":[{"name":"Department of Surgery, Sahlgrenska University Hospital and Sahlgrenska Academy, Gothenburg, Sweden"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Olivier R.","family":"Busch","sequence":"additional","affiliation":[{"name":"Amsterdam UMC, location University of Amsterdam, Department of Surgery, Amsterdam, the Netherlands"},{"name":"Cancer Center Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Butturini","sequence":"additional","affiliation":[{"name":"Department of Surgery, Pederzoli Hospital, Peschiera, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Capretti","sequence":"additional","affiliation":[{"name":"Pancreatic Surgery, Department of Biomedical Sciences, Humanitas University, Pieve Emanuele, Italy"},{"name":"IRCCS Humanitas Research Hospital, Rozzano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Riccardo","family":"Casadei","sequence":"additional","affiliation":[{"name":"Division of Pancreatic Surgery IRCCS, S. Orsola-Malpighi Hospital, Alma Mater Studiorum, University of Bologna, Bologna, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Safi","family":"Dokmak","sequence":"additional","affiliation":[{"name":"Department of Surgery, Beaujon Hospital, Paris, France"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bj\u00f8rn","family":"Edwin","sequence":"additional","affiliation":[{"name":"The Intervention Center, Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital and Institute of Clinical Medicine, University of Oslo, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Alessandro","family":"Esposito","sequence":"additional","affiliation":[{"name":"Department of General and Pancreatic Surgery - Pancreas Institute, University Hospital of Verona, Verona, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Massimo","family":"Falconi","sequence":"additional","affiliation":[{"name":"Department of Pancreatic and Transplant Surgery, San Raffaele Hospital IRCCS, Universit\u00e0 Vita-Salute, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giovanni","family":"Ferrari","sequence":"additional","affiliation":[{"name":"Department of Surgery, ASST Grande Ospedale Metropolitano Niguarda, Milano, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Thilo","family":"Hackert","sequence":"additional","affiliation":[{"name":"Department of General, Visceral, and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany"},{"name":"Department of General, Visceral and Thoracic Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Geert","family":"Kazemier","sequence":"additional","affiliation":[{"name":"Cancer Center Amsterdam, the Netherlands"},{"name":"Amsterdam UMC, location Vrije Universiteit, Department of Surgery, Amsterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Bas Groot","family":"Koerkamp","sequence":"additional","affiliation":[{"name":"Department of Surgery, Erasmus MC Cancer Institute, Rotterdam, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Ruben H.","family":"de Kleine","sequence":"additional","affiliation":[{"name":"Department of Surgery, University Medical Centre Groningen, Groningen, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Tobias","family":"Keck","sequence":"additional","affiliation":[{"name":"Department of Surgery, UKSH campus L\u00fcbeck, L\u00fcbeck, Germany"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Dyre B.","family":"Kleive","sequence":"additional","affiliation":[{"name":"Department of Hepato-Pancreato-Biliary Surgery, Oslo University Hospital, Rikshospitalet, Oslo, Norway"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Arto","family":"Kokkola","sequence":"additional","affiliation":[{"name":"Department of Surgery, University of Helsinki and Helsinki University Hospital, Helsinki, Finland"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"David","family":"Kooby","sequence":"additional","affiliation":[{"name":"Department of Surgery, Emory University Hospital, Atlanta"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Daan J.","family":"Lips","sequence":"additional","affiliation":[{"name":"Department of Surgery, Medisch Spectrum Twente, Enschede, the Netherlands"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Misha D. 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