title: Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery?
abstract: Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the above mentioned topics.
authors.affiliation: Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Germany. matthias.glanemann@charite.de
authors.forename: Matthias
authors.initials: M
authors.lastname: Glanemann
authors.forename: Baomin
authors.initials: B
authors.lastname: Shi
authors.forename: Feng
authors.initials: F
authors.lastname: Liang
authors.forename: Xiao-Gang
authors.initials: XG
authors.lastname: Sun
authors.forename: Marcus
authors.initials: M
authors.lastname: Bahra
authors.forename: Dietmar
authors.initials: D
authors.lastname: Jacob
authors.forename: Ulf
authors.initials: U
authors.lastname: Neumann
authors.forename: Peter
authors.initials: P
authors.lastname: Neuhaus
mesh_terms: D002445:Celiac Artery / Q000601:surgery; D006499:Hepatic Artery / Q000601:surgery; D006801:Humans; D010535:Laparoscopy / Q000379:methods; D008197:Lymph Node Excision / Q000379:methods; D017538:Mesenteric Artery, Superior / Q000601:surgery; D008642:Mesenteric Veins / Q000601:surgery; D010180:Pancreatectomy / Q000379:methods; D010190:Pancreatic Neoplasms / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods; D011169:Portal Vein / Q000601:surgery