[Extended lymphadenectomy and vascular resection for pancreatic cancer]

Pancreatic cancer is one of the most aggressive tumours. Despite enormous progress in multimodal therapeutic options, surgical resection remains the only chance for curative treatment. Several surgical procedures have been developed with the intention to improve the outcome of this disease. One of these procedures is extended lymphadenectomy. Another is the resection of main arterial or venous vessels, in case of tumour infiltration. So far there is no pivotal proof of any survival advantage of extended lymphadenectomy over standard pancreaticoduodenectomy. On the contrary there even exists evidence that an extended lymphadenectomy might increase morbidity. In case of tumour infiltration of the portal or the superior mesenteric vein, survival seems to be improved by resection of the affected vessel. Resection of the portal vein can be done safely without affecting morbidity or mortality. In the presence of tumour infiltrating the hepatic artery or other arterial vessels, there is still a need for controlled clinical trials to confirm any survival benefit from arterial resection.