Surgical techniques for resectable pancreatic cancer

Pancreatic cancer is a highly aggressive cancer with a rising incidence in most European countries. Due to both the aggressive biology of the disease and the late diagnosis in many cases, pancreatic duct carcinoma is still a disease with a poor prognosis. Today, surgical resection of localized tumor remains the only potentially curative option available for these patients. Advances in surgical techniques and perioperative care has improved significantly in the last 20 years, causing an extension of indications for surgical intervention. However, despite new diagnostic techniques, the surgical exploration still plays the key role for the finally assessment of resectability. For evaluation of local resectability, laparoscopy alone cannot generally be recommended today and explorative laparotomy is required. Contraindications for pancreatic resection are liver metastasis, peritoneal metastasis, and tumor infiltration of visceral arteries. The surgical management of pancreatic cancer consists of two phases: first, assessment of tumor resectability and second, if resectability is given, the pancreaticoduodenectomy with consecutive reconstruction. Standard surgical strategies are the classic pancreaticoduodenectomy including a distal gastrectomy and the pylorus-preserving pancreaticoduodenectomy (PPPD) preserving antral and pyloric function, respectively. Both surgical procedures are equally effective for the treatment of pancreatic carcinoma. Delicate lymphadenectomy during pancreaticoduodenectomy is important for radical oncological enforcement. An extended lymphadenectomy showed no benefit in several trials. Despite the encouraging advances in surgical treatment, actuarial 5-year survival rates after pancreatic resection are only at about 20%.