title: Surgery and cancer of the pancreas: will common sense become common practice?
abstract: Pancreatic cancer is a systemic disease for most patients. Operations with the intent to cure may be done safely (mortality, < 3%) with shorter hospital stays. Surgery has been minimally effective as a long-term cure. Endoscopic palliation of jaundice is becoming standard practice. Common sense dictates a defined and clear role for surgery (i.e., strict patient selection criteria). Surgery is of great value for small, localized lesions; of clear value as palliative therapy when nonoperative measures fail; and perhaps best applied after neoadjuvant chemoradiotherapy. Surgery is just part of the armamentarium available to treat pancreatic cancer. Novel systemic therapies, including chemotherapy, immunotherapy, and so-called targeted therapies, are becoming increasingly valuable in the management of this systemic disease and are discussed in detail in other articles in this issue.
authors.affiliation: Department of Surgery, Center for Biliary, Hepatic and Pancreatic Surgery, Dobbs Ferry, NY, USA.
authors.forename: Avram M
authors.initials: AM
authors.lastname: Cooperman
authors.forename: Andrew
authors.initials: A
authors.lastname: Fader
authors.forename: Brian
authors.initials: B
authors.lastname: Cushin
authors.forename: Francis
authors.initials: F
authors.lastname: Golier
authors.forename: Michael
authors.initials: M
authors.lastname: Feld
authors.forename: Franklin
authors.initials: F
authors.lastname: Kasmin
authors.forename: Seth
authors.initials: S
authors.lastname: Cohen
authors.forename: Panna
authors.initials: P
authors.lastname: Mahadevia
authors.forename: Kumudini
authors.initials: K
authors.lastname: Shah
mesh_terms: D000230:Adenocarcinoma / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D000971:Antineoplastic Combined Chemotherapy Protocols / Q000627:therapeutic use; D002100:Cachexia / Q000209:etiology / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D002779:Cholestasis / Q000209:etiology / Q000601:surgery; D003131:Combined Modality Therapy; D003952:Diagnostic Imaging; D004724:Endoscopy; D005260:Female; D017219:Gastric Outlet Obstruction / Q000209:etiology / Q000601:surgery; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D010190:Pancreatic Neoplasms / Q000150:complications / Q000175:diagnosis / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011838:Radiation-Sensitizing Agents / Q000627:therapeutic use; D018714:Radiotherapy, Adjuvant; D015607:Stents
chemical_list: D011838:Radiation-Sensitizing Agents