Surgical management of pancreatic neck cancer: an ongoing dilemma

The surgical management of pancreatic neck adenocarcinoma (neck PDAC) ranges from extended pancreaticoduodenectomy (ePD) to subtotal left pancreatectomy (sLP) and total pancreatectomy, with no clear consensus on the optimal approach. This study aimed to compare ePD and sLP in terms of perioperative and long-term outcomes. All patients who underwent ePD or sLP for neck PDAC were retrospectively reviewed and compared for perioperative and long-term outcomes. Forty-six patients were included: 18 (39.1%) underwent ePD and 28 (60.9%) sLP. ePD was associated with a higher rate of neoadjuvant treatment, longer operative time, and longer hospital stay. The most frequently involved lymph-node stations were #13-17 in the ePD group (44.4%) and #18 in the sLP group (42.9%). Overall survival (OS) was similar (p = 0.06), while disease-free survival (DFS) was longer in the sLP group (16 [9-22] vs 12 [5-18] months in the ePD group; p = 0.03). Due to the high rate of nodal metastases in station #13-17 and #18, both procedures may be inadequate as surgical treatment of neck PDAC. While sLP appears to offer better long-term outcomes, the heterogeneity of the study population limits generalizability. Larger prospective studies are needed to determine the most effective surgical approach.