PhD defence Q.P. (Kiki) Janssen

Dissertation in short:

This thesis shows that a neoadjuvant approach is superior to upfront surgery in patients with borderline resectable pancreatic cancer. For patients with resectable pancreatic cancer, clinical equipoise remains between the two treatment strategies. Radiotherapy following (m)FOLFIRINOX was associated with improved radical (R0) and node-negative resection rates, but a difference in survival could not be demonstrated. Future studies should focus on identifying who benefits from local therapies, both radiotherapy and surgery. For the diagnosis of pancreatic cancer, EUS-guided tissue acquisition showed a high sensitivity for malignancy of 85%, which is essential given the increasing use of neoadjuvant treatment. Although the sensitivity for malignancy of ERCP-guided brush for suspected pancreatic cancer is only 50%, a brush may prevent the need for an additional endoscopy-guided tissue acquisition procedure in half of the patients.