[Pancreas carcinoma--surgical therapy]

The incidence of pancreatic cancer is increasing. The tumor growths extremely aggressive, long-term prognosis is dismal. Nevertheless, surgical therapy provides the only chance for cure and longterm survival. Achievement of an R0 situation certainly is the primary surgical therapeutic goal. Reduction of surgical radicality in respect to the stomach and the pancreas itself obviously does not influence long-term survival of the patients. Thus, in the majority of patients the pylorus-preserving resection of the head of the pancreas seems to be the best operative strategy for resection of a carcinoma in the head of the pancreas. Concerning lymphadenectomy and resection of the portal or superior mesenteric vein surgical radicality is increasing during the last years. Perioperative mortality after resection of the head of the pancreas could be reduced in high volume centers below 5%. This is true even if parts of the portal or superior mesenteric vein are resected in addition. There are for the first time reports of patients who have survived longer than 5 years after resection of a pancreatic carcinoma. Further improvement of long-term survival, however, will not be achieved by increasing surgical aggressiveness but only by the use of new multimodal therapeutic protocols.