PhD defence E.N. (Emmelie) Dekker

Below is a brief summary of the dissertation:

This thesis focuses on improving treatment and outcomes for patients with localized pancreatic cancer, one of the most aggressive forms of cancer. It examines how the timing and choice of therapy, the use of biomarkers, surgical decision-making, and the management of complications can influence patient survival and recovery. For patients with resectable or borderline resectable tumors, neoadjuvant therapy—chemotherapy given before surgery—was studied using data from the PREOPANC trials. Both chemoradiotherapy and total neoadjuvant FOLFIRINOX increased survival and the likelihood of complete tumor removal compared to the traditional approach of surgery followed by chemotherapy. Changing chemotherapy regimens when the first was not tolerated proved feasible without reducing effectiveness.

The thesis also explored the collection and use of blood-based biomarkers to guide treatment decisions. High participation and successful sample collection in a nationwide trial demonstrated that biomarker research is feasible, and several markers were identified that may help predict which patients will respond best to specific therapies.

Finally, the research addressed surgical decision-making and patient safety. Prognostic models were developed to guide treatment based on tumor features, patient health, and response to therapy, including a web-based tool for personalized risk assessment. The role of staging laparoscopy, surgical complications, biliary events, and blood clots was evaluated, offering insights into how care can be tailored before and after surgery. Together, these findings contribute to more personalized care and improved outcomes for patients with localized pancreatic cancer.