title: Pancreatic neoplasms.
abstract: OBJECTIVE
  This review describes significant basic science and clinical advances in the field of pancreatic neoplasms.
  
  
  RESULTS
  Some of the genetic and molecular bases for the aggressive behavior of pancreatic cancer have been uncovered, and new targets for therapy have been identified. Various techniques for diagnosis and staging of this disease-endoscopic ultrasound, laparoscopy-continue to undergo evaluation. Surgical results show slightly improved long-term survival, and perioperative mortality rates remain low. The concept that locally invasive pancreatic cancer can be effectively downstaged and later resected has been called into question. Regional chemotherapy has shown promise, especially when combined with immunotherapy. Intraductal papillary mucinous tumors continue to be commonly encountered and their development and clinical course intensely studied. Acinar cell carcinomas are rare pancreatic neoplasms associated with postresection survival longer than ductal adenocarcinoma but shorter than endocrine carcinoma. Neoplasms metastatic to the pancreas can be resected safely and with improved survival compared with nonsurgical therapies.
  
  
  CONCLUSIONS
  The treatment of pancreatic neoplasms remains a major challenge for physicians and surgeons. Future progress requires sound scientific inquiry and continued clinical diligence.
authors.affiliation: Section of Gastrointestinal Surgery, David Geffen School of Medicine at UCLA, Los Angeles, California 90095-6904, USA.
authors.forename: John P
authors.initials: JP
authors.lastname: Duffy
authors.forename: Howard A
authors.initials: HA
authors.lastname: Reber