Pancreatic surgery for adenocarcinoma.
OBJECTIVE
Pancreatic resection remains among the most formidable and complex of abdominal surgical operations. Nonetheless, recent observations have continued to provide incremental improvement in both our evidence for treatment regimens and the technology, resulting in better outcomes.


RESULTS
Neoadjuvant regimens appear to have promise, at least in local control and perhaps in long-term survival. More extensive operations focusing on perineural invasion along with minimally invasive laparoscopic and robotic techniques are attracting increasing attention. The effectiveness of major vascular resection remains controversial. Concentration of patients in centers of expertise has contributed to improved outcomes.


CONCLUSIONS
Improved management of pancreatic resections for cancer with more extensive and less-invasive surgical techniques has increased the number of patients who are candidates for effective surgical treatment.
Department of Surgery, Massachusetts General Hospital, Boston, Massachusetts 02114, USA. awarshaw@partners.org
Andrew L
AL
Warshaw
Keith D
KD
Lillemoe
Carlos
C
Fernandez-del Castillo
D000230:Adenocarcinoma / Q000601:surgery*; D006801:Humans; D010535:Laparoscopy; D020360:Neoadjuvant Therapy; D010166:Palliative Care; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000601:surgery*; D012371:Robotics