Pancreatic Cancer Surgery: The State of the Art
Song Cheol Kim, Young Hoon Kim, Kwang Min Park and Young Ju Lee
Affiliation: Department of Surgery, Asan Medical Center, University of Ulsan College of Medicine, 86 Asan Byeongwongil, Songpagu, Seoul, 138-736, Korea.
Keywords: Pancreas cancer, surgery, laparoscopic surgery, robotic surgery, Pancreatic cancer, Surgical resection, adjuvant therapy, Randomized Trials, pathology, Pancreaticoduodenectomy, Clinical Outcomes
Pancreatic cancer patients have an extremely poor survival prognosis, and surgical resection remains the only
curative treatment. Greater experience in pancreatic surgery and developments in surgical techniques have reduced
surgical mortality and morbidity rates. It has been suggested that experienced pancreaticoduodenectomy centers should
have mortality rates of less than 5% and major complication rates of less than 40%.
Surgical resection followed by combined adjuvant therapy is currently the standard treatment for resectable pancreas
cancer. Patients with borderline or marginal resectable tumors are beginning to have favorable outcomes following
neoadjuvant chemotherapy or chemoradiation. A number of prospective randomized trials have concluded that “extended”
pancreaticoduodenectomy for pancreatic head cancer, involving radical dissection of lymph nodes and peripancreatic soft
tissue, does not appear to provide any survival benefits compared with “standard” pancreaticoduodenectomy. Conversely,
extensive surgery for pancreatic tail or body cancer (i.e., radical antegrade modular pancreatosplenectomy) can result in
favorable R0 resection rates and survival outcomes. However, more prospective randomized trial data are required before
these conclusions can be considered established. Laparoscopic approaches are being increasingly used in the field of
pancreatic tumor surgery. Moreover, robotic-assisted laparoscopic surgery has also been tried in some expert centers.
Again, at present a lack of outcome data prevent any definitive conclusion at this stage on the usefulness of those
approaches compared to standard open approaches.
Finally, a major problem hindering efforts to identify optimal surgical treatment modalities for pancreas cancer is the lack
of a clear definition and standardization of surgical procedures and pathologic descriptions. The American Hepato-
PancreatoBiliary Association/Society of Surgical Oncology/Society for Surgery of the Alimentary Tract conference on
pancreatic cancer held in 2008 resulted in a consensus statement as an important first step in overcoming this fundamental
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