[Treatment of pancreatic adenocarcinoma]

Better results of resections for pancreatic adenocarcinoma are reported in published data from 1990: 1. the lower mortality rate is probably not the only reason why these results are better; 2. the palliative resections rate seem to be lower (as the rates of exploratory laparotomies and by-pass procedures); 3. the impact of resection's quality on the results is difficult to demonstrate and the benefit of extended lymphadenectomy remains unclear; 4. moreover, in recent published series, many patients had adjuvant or neoadjuvant therapy, but often in uncontrolled studies. Multimodality treatment is probably useful for better local control and better disease free survival; this therapeutic approach is widely used today but the results remain to be confirmed by clinical trials. Unfortunately, 90% of the patients had locally advanced or metastatic disease at the time of diagnosis; in these patients clinical research is a challenge in order to change the prognosis; actually, epidemiological studies are still showing that quite all the patients die.