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Surgery Insight: surgical management of pancreatic cancer

Abstract

Pancreatic ductal adenocarcinoma is a common malignancy of the gastrointestinal tract. The number of new cases diagnosed and the number of deaths each year are almost identical, demonstrating the particularly dismal prognosis for patients affected by this disease. Despite recent advances in the field of medical and radiation oncology, and the introduction of neoadjuvant and adjuvant regimens, surgery remains the single most important modality for the treatment of pancreatic ductal adenocarcinoma. Surgery for pancreatic cancer is widely viewed as a complex procedure associated with considerable perioperative morbidity and mortality. Many aspects of surgery for pancreatic cancer, such as the extent of resection, the value of vascular resection, the use of laparoscopy, and the importance of treatment at high-volume centers, are currently under debate. This Review describes the current status of surgical treatment for pancreatic ductal adenocarcinoma, and highlights the new developments in this field.

Key Points

  • Pancreatic ductal adenocarcinoma is the fourth most common cause of cancer-related death, and the prognosis for patients with this disease is dismal

  • For patients with pancreatic cancer, complete surgical removal of the pancreatic tumor is the most important factor that determines survival

  • Patients treated at experienced centers demonstrate better short-term and long-term outcome; therefore, treatment should be performed by an experienced team

  • Vascular resections should be performed to achieve an R0 resection

  • Extended lymphadenectomy offers no survival benefit; however, extended resections are justified in order to achieve an R0 resection

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Figure 1: Small pancreatic tumor
Figure 2: Intraoperative photograph of a Whipple procedure with resection and end-to-end reconstruction of the superior mesenteric vein
Figure 3: Intraoperative photograph of a total pancreatectomy with resection of the celiac trunk and reconstruction using a saphenous vein graft
Figure 4: Intraoperative photographs of a Whipple procedure with extended lymphadenectomy (two views (A) (B) in the same patient)

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Correspondence to Markus W Büchler.

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Michalski, C., Weitz, J. & Büchler, M. Surgery Insight: surgical management of pancreatic cancer. Nat Rev Clin Oncol 4, 526–535 (2007). https://doi.org/10.1038/ncponc0925

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