Pancreatic surgery: cutting-edge developments and technology

In the 1980s, Japanese pancreatic surgeons used aggressive strategies to treat pancreatic cancer under the influence of Fortner's regional pancreatectomy and developed several surgical approaches including extended lymph node and connective tissue clearance with autonomic nerve dissection around the celiac and superior mesenteric arteries. Nagakawa's "translateral retroperitoneal approach" in extended radical pancreatectomy was accepted and used by many Japanese surgeons; however, whereas this operation prolonged postoperative survival, it also induced high rates of postoperative complications and ultimately failed to improve the quality of the patient's life. A pylorus-preserving pancreatoduodenectomy with modified extended dissection of the lymph node and connective tissues did not decrease the survival rate for resected patients but improved their quality of life. In the next decade, Takada developed duodenum-preserving total pancreatic head resection, which preserves the integrity of the digestive and biliary tracts. This operation, to anastomose the main pancreatic duct with the duodenum, is unique and is applicable to benign or low-grade malignant lesions of the pancreas. Adjuvant treatments have not offered satisfactory results as expected. Finally, it is recommended that the aggressive Japanese surgical strategies be reevaluated in a formal trial with a prospective randomized study to improve the quality and longevity of the patients' lives.