title: [Trend in the management of pancreatic adenocarcinoma--Japan vs. US and Europe].
abstract: Pancreatic adenocarcinoma remains to have poor prognosis. Most of all patients have locally advanced disease with or without distant disease when diagnosed. Current rationale for the treatment of pancreatic adenocarcinoma in the US and European countries consists of the following formula: (1) accurate staging by improved imaging. (2) a balanced-resection which means not too extensive not too limited. (3) centralized treatment in high-volume center with minimal surgical mortality. (4) surgery alone is not enough for cure and need more radical adjuvant or neoadjuvant therapy. On the other hands, Japanese surgeons had challenged to improve outcome by radical resections but did not show their advantages in terms of survival benefit as shown in recent randomized controlled trials. Now we should look back to surgical role and think 'who can benefit by surgical resection'. The efficacy of "Japanese" radical resection including vascular resection or pancreatic nerve plexus resection should be evaluated, although the devise of novel diagnostic modalities and more effective adjuvant or neoadjuvant therapy are crucial to improve prognosis of this disease.
authors.affiliation: Department of Surgery, Teikyo University School of Medicine, Tokyo, Japan.
authors.forename: Keita
authors.initials: K
authors.lastname: Wada
authors.forename: Tadahiro
authors.initials: T
authors.lastname: Takada
authors.forename: Hodaka
authors.initials: H
authors.lastname: Amano
authors.forename: Masahiro
authors.initials: M
authors.lastname: Yoshida
authors.forename: Fumihiko
authors.initials: F
authors.lastname: Miura
authors.forename: Naoyuki
authors.initials: N
authors.lastname: Toyota
authors.forename: Kenichiro
authors.initials: K
authors.lastname: Kato
authors.forename: Takahiro
authors.initials: T
authors.lastname: Isaka
authors.forename: Ikuo
authors.initials: I
authors.lastname: Nagashima
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D003131:Combined Modality Therapy / Q000639:trends; D004386:Duodenum / Q000601:surgery; D005060:Europe; D006801:Humans; D007564:Japan; D008197:Lymph Node Excision; D009197:Myenteric Plexus / Q000601:surgery; D009367:Neoplasm Staging; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000628:therapy*; D011169:Portal Vein / Q000601:surgery; D015996:Survival Rate; D014481:United States