[Technical problems and solutions in pancreatic resection]

There are many factors that make pancreatic surgery complex and troublesome, among them anatomical relations of the pancreas and morphological variations caused by inflammatory and neoplastic diseases. Pancreatic resection, specifically of the head, for specific oncological situations arises technical problems due to the frequency of vascular or biliary variants. The vascular invasion by the tumor determines major difficulties; in these cases an en-bloc resection depends upon the biology of the tumor and the grade of infiltration and segment of vascular axis involved. Other technical problems follow lymphadenectomy of retroperitoneal and perivascular tissue in the effort to obtain a curative resection for neoplastic disease. Eventually other solutions are prospected by a conservative surgery in case of benign or borderline malignant tumors in which a "sparing" demolition is adopted regarding the pancreas and the surrounding organs (spleen, stomach and duodenum). It is well known that the results of pancreatic resection depend on the qualification of the surgical team and the high patient volume of the center were it is more safely performed.