[Treatment of carcinoma of the pancreatic head]

For patients with carcinoma in the head of the pancreas surgical resection remains the only chance of cure. Perioperative mortality could be reduced in the last years dramatically, postoperative morbidity, however, remains high. Only a small percentage of all patients suffering from pancreas carcinoma are good candidates for an operative therapy. The most frequent contraindications are metastases in the liver or the peritoneum or a locally too advanced tumor. The extent of surgical resection necessary in patients with pancreas carcinoma is still in discussion. Even after an operation under curative aspects long term results remain disappointing. Median survival still ranges only about 16 months. A substantial improvement of long term- survival can only be expected from new multimodal therapeutic strategies. Adjuvant chemotherapy should strongly be recommended after resection of a pancreas carcinoma. Neoadjuvant therapy on the other hand is still an experimental procedure and under evaluation in ongoing prospective randomized studies.