[Pancreatic carcinoma: surgical therapy]

The incidence of pancreatic diseases has increased over the last years. Low morbidity and mortality rates after pancreatic resection procedures and an increasing 5-years survival rate allow more liberal indications for operation. These better results are due to careful preoperative investigations, perfect surgical techniques and the use of Octreotide perioperatively to reduce morbidity and leakage rate. Therefore resections for cancer of the pancreas should be carried out whenever possible, as well in curative as in palliative attempt. We discuss the indications and contraindications of pancreatic resection. At last, the decision to perform a resection depends of the tumor extension found at the operation and of the surgeon's skill. Infiltration of the wall of portal or superior mesenteric vein and retroperitoneum are not always definitive criteria of non-resectability, as there is still the possibility of vessel resection or partial excision of the retroperitoneum followed by locoregional chemotherapy. Today encouraging results of pancreatic resections allow the surgeon to carry out pancreatic resections whenever possible in patients fit for the operation. These resections should be carried out by experienced surgeons who carry out more than 10 pancreas resections per year and achieve a mortality rate below 5%.