[Preventive Pancreatic Surgery]

One of the principal reasons for the poor prognosis of pancreatic carcinoma is its frequently late diagnosis. Consequently, prevention and early detection are of paramount importance. Preventive pancreatic surgery may be considered in individuals with markedly increased disease risk or with detectable morphological precursor lesions, although only approximately 20-30% of pancreatic carcinomas arise in this context.An increased risk may be conferred by germline mutations, hereditary syndromes, or a positive family history. The evidence supporting prophylactic resection in such settings remains exceedingly limited. Accordingly, surgical intervention is restricted to highly selected cases and should be undertaken solely after individualised, interdisciplinary evaluation within specialised centres. In the majority of cases, risk-adapted surveillance programmes constitute the standard of care.With respect to morphological precursor lesions, particularly cystic pancreatic neoplasms, the evidence base is considerably more robust. Over recent decades, international consensus guidelines with clearly defined risk criteria have been established, thereby facilitating precise stratification for either surgical resection or structured surveillance. Main-duct IPMN, MCN, SPN, as well as lesions fulfilling high-risk criteria, warrant early operative management. In contrast, the most frequent precursor lesions-pancreatic intraepithelial neoplasias (PanIN)-are generally not detectable in clinical practice and therefore currently have only limited relevance for preventive strategies.Future progress in genetics, diagnostic modalities, minimally invasive surgery, as well as prospective clinical trials and registry initiatives, is expected to render preventive approaches increasingly precise, safe, and evidence-based.