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Surgical Resection for Pancreatic Cancer

  • Nuh N. Rahbari
  • Nathan Mollberg
  • Moritz Koch
  • John P. Neoptolemos
  • Jürgen Weitz
  • Markus W. Büchler

Abstract:

The prognosis of patients diagnosed with ductal adenocarcinoma of the pancreas remains poor. Within the multidisciplinary management of this disease surgeons play an integral role, as surgical resection provides the only chance for cure. Within the past two decades substantial advances have been made in the fields of diagnostic imaging, surgical technique, and perioperative care. This development significantly improved mortality of patients undergoing pancreatic surgery and enabled more extended resections. The location of the tumor within the pancreas determines the surgical procedure. Pancreatoduodenectomy represents the standard of care for tumors of the pancreatic head. According to current evidence the pylorus may be preserved with no adverse impact on survival. Distal pancreatectomy with splenectomy is commonly performed for cancer of the pancreatic body and tail. In selected cases total pancreatectomy may be performed with acceptable morbidity and mortality. Extended lymphadenectomy has not been shown to improve late survival and is currently not recommended as a routine procedure. En bloc vascular resection including the portal and/or the superior mesenteric vein is justified, if macroscopic tumor clearance is achievable. Although perioperative mortality could be substantially reduced, morbidity of patients undergoing pancreatic resection remains high. While better perioperative outcome as well as oncological results are achieved at high-volume centers further effort is required to reduce the incidence of postoperative delayed gastric emptying, pancreatic fistula, and intraabdominal abscess. Furthermore, the value of preoperative biliary drainage and the optimal intervention for palliation of patients with unresectable tumors and biliary obstruction remain to be determined.

Keywords

Pancreatic Cancer Gastric Emptying Superior Mesenteric Artery Pancreatic Fistula Pancreatic Head 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.

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Copyright information

© Springer Science+Business Media, LLC 2010

Authors and Affiliations

  • Nuh N. Rahbari
    • 1
  • Nathan Mollberg
    • 1
  • Moritz Koch
    • 1
  • John P. Neoptolemos
    • 2
  • Jürgen Weitz
    • 1
  • Markus W. Büchler
    • 1
  1. 1.Department of SurgeryUniversity of Heidelberg, Im Neuenheimer FeldHeidelbergGermany
  2. 2.Division of Surgery and OncologySchool of Cancer Studies, University of LiverpoolLiverpoolUK

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