Current standards of surgery for pancreatic cancer.
BACKGROUND
Pancreatic cancer carries a dismal prognosis but there has been a vast increase in evidence on its management in the past decade.


METHODS
An electronic and manual search was performed for articles on the surgical treatment of pancreatic cancer published in the past 10 years.


RESULTS
Six major areas of advancement were identified. Groups at high risk of developing pancreatic cancer, notably those with chronic pancreatitis and hereditary pancreatitis, have been defined, raising the need for secondary screening. Methods of staging pancreatic cancer for resection have greatly improved but accuracy is still only 85-90 per cent. Pylorus-preserving partial pancreatoduodenectomy without extended lymphadenectomy is the simplest procedure; it does not compromise long-term survival. Adjuvant chemotherapy significantly improves long-term survival. Patients who are free from major co-morbidity have better palliation by surgery (with a double bypass) than by endoscopy. High-volume centres improve the results of surgery for all outcome measures including long-term survival.


CONCLUSIONS
The surgical management of pancreatic cancer has undergone a significant change in the past decade. It has moved away from no active treatment. The standard of care can now be defined as potentially curative resection in a specialist centre followed by adjuvant systemic chemotherapy.
Alexakis
N
N
Department of Surgery, University of Liverpool, Royal Liverpool University Hospital, 5th floor, UCD Building, Daulby Street, Liverpool L69 3GA, UK.
Halloran
C
C
Raraty
M
M
Ghaneh
P
P
Sutton
R
R
Neoptolemos
J P
JP
D006801:Humans; D010166:Palliative Care; D010179:Pancreas / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000209:etiology / Q000473:pathology / Q000601:surgery*; D011379:Prognosis; D012307:Risk Factors; D016019:Survival Analysis