Surgical treatment of pancreatic carcinoma: curative resections

Curative resection of pancreatic adenocarcinoma can only be performed in 10% of patients. This review article reports resectability rates and criteria, results of pancreatic resection and prognostic factors. Lymph node and/or vascular involvement and retroperitoneal tissue invasion constitute very poor prognostic factors; however, lymph node involvement limited to the first draining nodes and limited invasion of the mesenteric-portal vein do not constitute contraindications to surgical resection. Cephalic pancreaticoduodenectomy is still the reference procedure and its postoperative mortality has greatly decreased. The risk of pancreatic fistula mainly depends on the friability of the pancreatic stump. Median survival rate after tumour resection is usually limited between 12 and 18 months. Five-year actuarial survival rate is no more than 5%, but after curative resection (RO), it may be as high as 20 to 25% in recent surgical series. Concomitant or neoadjuvant chemotherapy-radiotherapy, currently under evaluation, may increase resection and survival rates. (C) 2000 Editions scientifiques et medicales Elsevier SAS.