Surgical management of pancreatic cancer - standard and extended resections

BACKGROUND: Pancreatic cancer is still associated with a poor prognosis and remains - as the fourth leading cause of cancer-related mortality - a therapeutic challenge. Overall long-term survival is about 1-5%, in only 10-20% of pancreatic cancer patients potentially curative surgery is possible, increasing 5-year survival rates to approximately 20-25%. Pancreatic surgery is a technically challenging procedure and has significantly changed during the past decades with regard to technical aspects as well as perioperative care. METHODS: The current state of pancreatic cancer surgery is summarized with regard to standard indications and extended approaches. The available literature including randomized controlled trials and meta-analyses are included in this review article. RESULTS: Standardized resections are well established and can be carried out with low morbidity and mortality below 5% in high-volume institutions. Furthermore, there is growing evidence that also more extended resections including multivisceral approaches, vessel reconstructions or surgery for tumor recurrence can be carried out safely with favorable outcome. In addition, the impact of adjuvant treatment, especially chemotherapy, has increased dramatically within recent years, leading to significantly improved survival in resected pancreatic cancer patients. CONCLUSIONS: Pancreatic resections are the basis of any curative approach in pancreatic cancer treatment and can be performed with low morbidity and mortality in high-volume institutions. Furthermore, pancreatic cancer needs to be in an interdisciplinary approach to achieve best results.