Overview of the research line

1) IPMN and Pancreatic Cystic Neoplasms:

Intraductal Papillary Mucinous Neoplasms (IPMN) and other pancreatic cystic neoplasms represent a spectrum of lesions with varying malignant potential. Research in this area focuses on improving risk stratification, surveillance strategies, and management decisions.

• Risk stratification:

• Developing more accurate predictive models for malignant transformation
• Investigating novel imaging techniques and biomarkers for better characterization of cystic lesions
• Studying the molecular and genetic profiles of different cystic neoplasms to identify high-risk features

• Surveillance and management:

• Optimizing surveillance protocols to balance early detection of malignancy with cost-effectiveness and patient burden
• Evaluating the role of endoscopic ultrasound-guided through-the-needle biopsy in diagnosis and risk assessment
• Investigating the potential of artificial intelligence in analyzing imaging data for improved decision-making

• Treatment strategies:

• Exploring minimally invasive and organ-sparing surgical techniques for low-risk lesions
• Evaluating the efficacy of ablative therapies (e.g., radiofrequency ablation, ethanol injection) for selected cystic lesions
• Investigating chemopreventive strategies to reduce the risk of malignant transformation in high-risk IPMNs

2) Pancreatic Cancer Surgery:

Surgical resection remains the only potentially curative treatment for pancreatic cancer. Research in pancreatic cancer surgery focuses on improving surgical techniques, expanding surgical indications, and enhancing perioperative management to improve both short-term and long-term outcomes.

• Surgical techniques and approaches:

- Advancing minimally invasive techniques, including robotic pancreaticoduodenectomy and distal pancreatectomy
- Exploring extended lymphadenectomy and vascular resection techniques to improve oncological outcomes
- Investigating the role of local therapies (e.g., irreversible electroporation) as adjuncts to surgery for borderline resectable tumors

• Perioperative management:

- Optimizing enhanced recovery after surgery (ERAS) protocols specific to pancreatic surgery
- Studying the impact of prehabilitation programs on surgical outcomes and patient recovery
- Investigating novel strategies to reduce postoperative pancreatic fistula and other surgery-specific complications

• Neoadjuvant and adjuvant strategies:

- Evaluating the role of neoadjuvant chemotherapy and/or radiation therapy in improving resectability and survival
- Investigating personalized adjuvant treatment regimens based on molecular profiling of resected tumors
- Exploring the potential of immunotherapy in the perioperative setting to reduce recurrence and improve long-term survival

3)  Pancreatic Neuroendocrine Neoplasms (PanNENs):

Pancreatic neuroendocrine neoplasms are a diverse group of tumors with varying clinical behaviors and prognoses. Research in this field aims to improve understanding of tumor biology, enhance diagnostic accuracy, and develop more effective treatment strategies for both functional and non-functional PanNENs.

• Molecular characterization and classification:

- Investigating genomic and epigenomic alterations to identify new therapeutic targets and prognostic markers
- Refining grading systems and developing molecular classifications to better predict tumor behavior and guide treatment
- Studying the role of circulating tumor DNA and other liquid biopsy techniques for diagnosis and monitoring

• Imaging and diagnostics:

- Developing novel radiotracers for PET imaging to improve tumor detection and characterization
- Exploring the use of artificial intelligence in image analysis for more accurate staging and treatment response assessment
- Investigating blood-based biomarkers for early detection and monitoring of disease progression

• Treatment strategies:

- Evaluating the efficacy of peptide receptor radionuclide therapy (PRRT) in different PanNEN subtypes and exploring combination therapies
- Investigating targeted therapies, including mTOR inhibitors, tyrosine kinase inhibitors, and emerging molecular targets
- Studying the role of liver-directed therapies (e.g., transarterial embolization, radioembolization) for metastatic disease
- Exploring the potential of immunotherapy, particularly for high-grade neuroendocrine carcinomas

4) Prospective Trials

• SONAR (Randomized Clinical Trials) for Surgery vs. Chemotherapy for Oligometastatic Pancreatic Ductal Adenocarcinoma to the Liver
• ROBIN (Prospective Trial) on quality of life after resection for locally advanced pancreatic ductal adenocarcinoma
• TRIVIAL trial (Prospective Observational Trial) on the possible follow-up discontinuation of stable IPMN of the pancreas without features of malignancy

5 publications

Funding

•STARS Grant University of Padova for the assessment of biomarkers predictive of malignant degeneration of IPMN – Collaborative research with UCSF San Francisco University

People involved:

Umberto Cillo, DISCOG
Giovanni Marchegiani, DISCOG
Domenico Bassi, AOPD
Simone Serafini, AOPD
Giampaolo Perri, DISCOG
Nicola Canitano, DISCOG
Riccardo Guastella, AOPD