Radical resection of pancreatic cancer.
BACKGROUND
Pancreatic adenocarcinoma (PCa) is a disease with dismal prognosis, and the only possibility of cure, albeit small, is based on the combination of complete resection with negative histopathological margins (R0 resection) with adjuvant treatment. Therefore, a lot of effort has been made during the last decade to assess the role of extensive surgery in both local recurrence and survival of patients with PCa.


METHODS
Medline search and manual cross-referencing were utilized to identify published evidence-based data for PCa surgery between 1973 and 2006, with emphasis to feasibility, efficacy, long-term survival, disease free survival, recurrence rates, pain relief and quality of life.


RESULTS
Extended surgery is safe and feasible in high volume surgical centers with comparable short-term results. Organ preserving surgery is a main goal because of quality of life reasons and is performed whenever possible from the tumor extent. Concerning long-term survival major vein resection does not adversely affect outcome. To date, there are no changes in long-term survival attributed to the extended lymph node dissection. However, there is a benefit in locoregional control with fewer local recurrences and extended lymphadenectomy allows better staging for the disease.


CONCLUSIONS
Extended PCa surgery is safe and feasible despite the inconclusive results in patient's survival benefit. In the future, appropriately powered randomized trials of standard vs. extended resections may show improved outcomes for PCa patients.
Koliopanos
Alexander
A
Department of Surgery, G. Gennimatas Hospital, Athens 14233, Greece.
Avgerinos
C
C
Farfaras
Athanasios
A
Manes
C
C
Dervenis
Christos
C
D000230:Adenocarcinoma / Q000401:mortality / Q000601:surgery*; D006801:Humans; D008197:Lymph Node Excision; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*