[Surgical aspects of focal pancreatic lesions]

Focal lesions of the pancreas or its surroundings comprise a variety of morphologic substrates that do not always require treatment. Cysts and neoplasms are the two important groups. Postpancreatic cysts are increasingly and successfully treated by endoscopy and interventions guided by ultrasound. They have to be distinguished from cystic neoplasms or intracavitary hemorrhage which have to be approached by primary surgery. Pancreatic malignancies do not necessarily invite to a fatalistic attitude. Only ductal pancreatic cancer carries a still poor prognosis although we have achieved a 20% 5 year survival rate if resection without residual tumor was possible. If lymph nodes were not involved 43% of patients survived for 5 years. Periampullary carcinoma and the other pancreatic neoplasms carry a much better prognosis. The search for focal pancreatic lesions must be particularly thorough in patients presenting with diabetes of sudden onset, persistent hyperamylasemia and in some cases with an acute, possibly severe pancreatitis without apparent cause and an age of over 40 years.