Surgical techniques for pancreatic cancer

Surgical resection of pancreatic adenocarcinoma offers the only chance for long-term cure. Over the past 2 decades significant advances have been made in both the surgical techniques and the perioperative care of patients with pancreatic cancer. The operative management of pancreatic cancer involving the head, neck, and uncinate process consists of 2 phases: first, assessing tumor resectability and then, if the tumor is resectable, completing a pancreaticoduodenectomy and restoring gastrointestinal continuity. In this article, we describe our current techniques for resection of pancreatic cancer, review operative palliation for unresectable cancer, and discuss several controversies in the operative management of pancreatic cancer including: 1) the role of extended lymphadenectomy, 2) pylorus preservation and 3) pancreaticojejunostomy versus pancreaticogastrostomy for pancreatic duct reconstruction.