Approaches to localized pancreatic cancer

Pancreatic cancer is one of the most devastating human malignancies, with a mortality rate that almost equals its incidence rate. In cases of localized pancreatic cancer, surgical resection offers a chance for cure or at least prolonged survival. Adjuvant chemotherapy has been established as the standard of care; prospective, randomized controlled trials have demonstrated a distinct survival benefit of 5-fluorouracil/folinic acid or gemcitabine following surgical resection. More aggressive approaches, including neoadjuvant protocols, venous resections, and extended lymphadenectomy, have been suggested to improve long-term survival. However, based on the available data, there is either no benefit for these approaches or the evidence is not conclusive. Thus, further randomized controlled trials are needed to determine the role of novel therapy regimens in the treatment of pancreatic cancer.