title: Current status of surgery for pancreatic cancer.
abstract: BACKGROUND
  In Japan the annual incidence of pancreatic cancer has increased over the last decade, but no advancement has been made in the long-term prognosis after resection. The significant differences in the surgical procedures between Western countries and Japan have been discussed. Therefore, an adequate comparison and analysis of the data from Japan, Europe and the USA is required. This review evaluates many important published reports from Japan which influence surgical procedure.
  
  
  METHODS
  Several important highlights and controversies regarding the concept of surgical treatment and surgical procedure are discussed comparing the results in Japan with those in Western countries.
  
  
  RESULTS
  No significant difference in diagnostic strategy using various imaging methods was observed between Japan and Europe. The stage classification for pancreatic cancer by the Japanese Pancreatic Society (JPS) seems to be superior to others, because the results on long-term prognosis after pancreatectomy of cases with pancreatic head cancer, diagnosed as tubular adenocarcinoma, has been arranged logically. Pancreatectomy with extended radical dissection is recommended in Japan, but several clinical studies from Europe and the USA suggest that this is ineffective. The basic concepts of this controversy have recently come closer altogether. Scientific clinical trials for instance on the necessity of adjuvant treatment, etc., are now on-going.
  
  
  CONCLUSIONS
  The characteristics on diagnosis and treatment of pancreatic cancer in Japan are described. The JPS registration system for pancreatic cancer can provide much more information, i.e. dependency on diagnostic methods, highly frequent sites of lymph node and of distant metastases, the prognosis of small pancreatic cancers, etc. The indication for any surgical treatments should be limited to cases with the possibility of cancer free margins.
authors.affiliation: Department of Gastrointestinal Surgery and Oncological Surgery, Sapporo Medical University School of Medicine, Sapporo, Japan. a.narita@sapmed.ac.jp
authors.forename: Koichi
authors.initials: K
authors.lastname: Hirata
authors.forename: Shinichi
authors.initials: S
authors.lastname: Egawa
authors.forename: Yasutoshi
authors.initials: Y
authors.lastname: Kimura
authors.forename: Takayuki
authors.initials: T
authors.lastname: Nobuoka
authors.forename: Hidenori
authors.initials: H
authors.lastname: Oshima
authors.forename: Tadashi
authors.initials: T
authors.lastname: Katsuramaki
authors.forename: Toru
authors.initials: T
authors.lastname: Mizuguchi
authors.forename: Tomohisa
authors.initials: T
authors.lastname: Furuhata
mesh_terms: D006801:Humans; D007564:Japan; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*