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How to Treat Resectable Disease

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Book cover Current and Emerging Therapies in Pancreatic Cancer

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Abstract

Surgical resection is of critical importance in the treatment of pancreatic cancer. The majority of patients present with painless jaundice with the management of jaundice an important decision-making process prior to surgery. Work-up typically includes laboratory evaluation, and imaging typically consists of pancreatic protocol CT. MRI or endoscopic ultrasound (EUS) is used in selected cases. If no distant metastases are found, determination of resectable disease is based on the relationship of the tumor to mesenteric vasculature. The definitions of resectable, borderline resectable, and locally advanced unresectable are discussed and illustrated. Many differences in surgical technique have been researched over many years including pylorus-preserving pancreaticoduodenectomy (PPPD), different anastomotic techniques, the use of drains, and the value of extended lymphadenectomy, all of which are addressed. No major difference in outcome has been shown with any of the above changes in technique. While current recommendations are for patients with resectable disease to undergo resection unless enrolled in a neoadjuvant therapy trial, most pancreatic surgeons will agree that once a tolerable, efficacious systemic therapy is identified, it is best administered prior to surgery. Until then, thoughtful consideration for resection utilizing high-quality cross-sectional imaging, sound surgical expertise, and a multidisciplinary team provides optimal outcomes.

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Author information

Authors and Affiliations

  1. James Cancer Center and Solove Research Institute, Ohio State University, 390 W. 10th Avenue, Columbus, OH, 43210, USA

    Mary Dillhoff M.D., M.S.

  2. 21st Century Oncology, Fort Myers, FL, USA

    Mark Bloomston M.D.

Authors
  1. Mary Dillhoff M.D., M.S.
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  2. Mark Bloomston M.D.
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Correspondence to Mary Dillhoff M.D., M.S. .

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Editors and Affiliations

  1. Mayo Clinic Cancer Center, Scottsdale, Arizona, USA

    Tanios Bekaii-Saab

  2. Winship Cancer Institute, Emory University, Atlanta, Georgia, USA

    Bassel El-Rayes

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Dillhoff, M., Bloomston, M. (2018). How to Treat Resectable Disease. In: Bekaii-Saab, T., El-Rayes, B. (eds) Current and Emerging Therapies in Pancreatic Cancer . Springer, Cham. https://doi.org/10.1007/978-3-319-58256-6_9

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  • DOI: https://doi.org/10.1007/978-3-319-58256-6_9

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