title: Extended pancreatectomy in pancreatic ductal adenocarcinoma: definition and consensus of the International Study Group for Pancreatic Surgery (ISGPS).
abstract: BACKGROUND
  Complete macroscopic tumor resection is one of the most relevant predictors of long-term survival in pancreatic ductal adenocarcinoma. Because locally advanced pancreatic tumors can involve adjacent organs, "extended" pancreatectomy that includes the resection of additional organs may be needed to achieve this goal. Our aim was to develop a common consistent terminology to be used in centers reporting results of pancreatic resections for cancer.
  
  
  METHODS
  An international panel of pancreatic surgeons working in well-known, high-volume centers reviewed the literature on extended pancreatectomies and worked together to establish a consensus on the definition and the role of extended pancreatectomy in pancreatic cancer.
  
  
  RESULTS
  Macroscopic (R1) and microscopic (R0) complete tumor resection can be achieved in patients with locally advanced disease by extended pancreatectomy. Operative time, blood loss, need for blood transfusions, duration of stay in the intensive care unit, and hospital morbidity, and possibly also perioperative mortality are increased with extended resections. Long-term survival is similar compared with standard resections but appears to be better compared with bypass surgery or nonsurgical palliative chemotherapy or chemoradiotherapy. It was not possible to identify any clear prognostic criteria based on the specific additional organ resected.
  
  
  CONCLUSIONS
  Despite increased perioperative morbidity, extended pancreatectomy is warranted in locally advanced disease to achieve long-term survival in pancreatic ductal adenocarcinoma if macroscopic clearance can be achieved. Definitions of extended pancreatectomies for locally advanced disease (and not distant metastatic disease) are established that are crucial for comparison of results of future trials across different practices and countries, in particular for those using neoadjuvant therapy.
authors.affiliation: Department of Surgery, Klinikum Großhadern, University of Munich, Munich, Germany.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
authors.affiliation: Department of Gastrointestinal Surgery, Penn Surgery, Hospital of the University of Pennsylvania, Philadelphia, PA.
authors.forename: Charles M
authors.initials: CM
authors.lastname: Vollmer
authors.affiliation: Department of Digestive Surgery, Centre Hospitalier Intercommunal, Poissy, France.
authors.forename: Abe
authors.initials: A
authors.lastname: Fingerhut
authors.affiliation: Department of Surgery, Jefferson Pancreas, Biliary and Related Cancer Center, Thomas Jefferson University, Philadelphia, PA.
authors.forename: Charles J
authors.initials: CJ
authors.lastname: Yeo
authors.affiliation: Department of Molecular and Clinical Cancer Medicine, Liverpool Cancer Research-UK Centre, University of Liverpool, Liverpool, UK.
authors.forename: John P
authors.initials: JP
authors.lastname: Neoptolemos
authors.affiliation: Department of HPB Surgery, Hopital Edouard Herriot, Lyon, France.
authors.forename: Mustapha
authors.initials: M
authors.lastname: Adham
authors.affiliation: Department of Surgery, Karolinska Institutet at Karolinska University Hospital, Huddinge, Stockholm, Sweden.
authors.forename: Ake
authors.initials: A
authors.lastname: Andrén-Sandberg
authors.affiliation: Department of General Surgery, Mayo Clinic, Jacksonville, FL.
authors.forename: Horacio J
authors.initials: HJ
authors.lastname: Asbun
authors.affiliation: Department of Surgery and Oncology, Pancreas Institute, University of Verona, Verona, Italy.
authors.forename: Claudio
authors.initials: C
authors.lastname: Bassi
authors.affiliation: Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Max
authors.initials: M
authors.lastname: Bockhorn
authors.affiliation: Department of HPB & Transplant Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
authors.forename: Richard
authors.initials: R
authors.lastname: Charnley
authors.affiliation: Professorial Surgical Unit, University of Dublin, Trinity College, Dublin, Ireland.
authors.forename: Kevin C
authors.initials: KC
authors.lastname: Conlon
authors.affiliation: Department of First Surgery, Agia Olga Hospital, Athens, Greece.
authors.forename: Christos
authors.initials: C
authors.lastname: Dervenis
authors.affiliation: Department of Surgery, Clinic Hospital of Barcelona, University of Barcelona, Barcelona, Spain.
authors.forename: Laureano
authors.initials: L
authors.lastname: Fernandez-Cruz
authors.affiliation: Department of Surgery, Klinikum rechts der Isar, Technische Universität München, Munich, Germany.
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.affiliation: Department of Surgery, Academic Medical Centre, University of Amsterdam, Amsterdam, The Netherlands.
authors.forename: Dirk J
authors.initials: DJ
authors.lastname: Gouma
authors.affiliation: Academic Unit of Surgery, University of Glasgow, Glasgow, UK.
authors.forename: Clem W
authors.initials: CW
authors.lastname: Imrie
authors.affiliation: Department of Surgery, Massachusetts General Hospital, Harvard Medical School, Boston, MA.
authors.forename: Keith D
authors.initials: KD
authors.lastname: Lillemoe
authors.affiliation: First Surgical Clinic, Clinical Center of Serbia, University of Belgrade, Belgrade, Serbia.
authors.forename: Miroslav N
authors.initials: MN
authors.lastname: Milićević
authors.affiliation: Department of General Surgery, Instituto Clinico Humanitas IRCCS, University of Milan, Milan, Italy.
authors.forename: Marco
authors.initials: M
authors.lastname: Montorsi
authors.affiliation: Department of Gastrointestinal and HPB Surgical Oncology, Tata Memorial Hospital, Mumbai, India.
authors.forename: Shailesh V
authors.initials: SV
authors.lastname: Shrikhande
authors.affiliation: Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Yogesh K
authors.initials: YK
authors.lastname: Vashist
authors.affiliation: Department of General-, Visceral- and Thoracic-Surgery, University Hospital Hamburg-Eppendorf, Hamburg, Germany.
authors.forename: Jakob R
authors.initials: JR
authors.lastname: Izbicki
authors.affiliation: Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany. Electronic address: markus.buechler@med.uni-heidelberg.de.
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D006801:Humans; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011183:Postoperative Complications; D016896:Treatment Outcome