[Management of pancreatic cancer: recent advances]

Pancreatic cancer is still associated with a poor prognosis and remains the fourth leading cause of cancer related mortality. Overall, long-term survival is about 5 %. However, when pancreatic cancer can be resected, five-year survival rates increase to approximately 25 %. Pancreatic surgery is technically challenging and has significantly changed over the past decades with regard to technical aspects as well as perioperative care. Standardized resections can be carried out with low morbidity and a mortality below 5 % in high volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcomes. In addition, about 20 percent of all primarily locally irresectable tumors may profit from neoadjuvant radiochemotherapy. The impact of adjuvant chemotherapy has increased over recent years, leading to improved long-term survival. Thus, pancreatic cancer should be treated in an interdisciplinary team at a pancreatic cancer center. Cystic pancreatic tumors (e. g. IPMNs) are diagnosed more and more frequently over the past decade. Often, these tumors are diagnosed in premalignant or early invasive stages. While the outcome of late tumor stages of cystic and ductal pancreatic carcinomas is identical to ductal adenocarcinomas, the long-term outcome of prophylactic resection of premalignant or resection of early tumor stages of cystic tumors is excellent. Thus, early surgical treatment must be considered in cystic pancreatic tumors.