What constitutes curative pancreatectomy for adenocarcinoma of the pancreas?

This is a review of the recent advances in radical pancreatectomy for adenocarcinoma of the pancreas. Over the last three decades, the operative mortality rate has decreased sharply to below 5%. On the basis of the clinicopathological evidence of the extent of the cancer, extended pancreatectomy with lymphatic and connective tissue clearance, in place of the traditional Whipple's procedure or total pancreatectomy is increasingly justified. In fact, use of this procedure has markedly reduced locoregional recurrence, and has improved the 5-year survival rate of pancreatic adenocarcinoma patients to more than 25%. However, such a beneficial effect is limited to those with less advanced cancer, for example, that in which the main tumor is 4 cm or less in diameter, nodal involvement is limited to the peripancreatic groups, and portal vein invasion is slight or absent. Future efforts should be aimed at developing adjuvant therapy that is equally as effective in reducing both locoregional recurrence and liver metastasis.