title: Improving outcomes in pancreatic cancer: key points in perioperative management.
abstract: This review focused in the perioperative management of patients with pancreatic cancer in order to improve the outcome of the disease. We consider that the most controversial points in pancreatic cancer management are jaundice management, vascular resection and neo-adjuvant therapy. Preoperative biliary drainage is recommended only in patients with severe jaundice, as it can lead to infectious cholangitis, pancreatitis and delay in resection, which can lead to tumor progression. The development of a phase III clinical trial is mandatory to clarify the role of neo-adjuvant radiochemotherapy in pancreatic adenocarcinoma. Venous resection does not adversely affect postoperative mortality and morbidity, therefore, the need for venous resection should not be a contraindication to surgical resection in selected patients. The data on arterial resection alone, or combined with vascular resection at the time of pancreatectomy are more heterogeneous, thus, patient age and comorbidity should be evaluated before a decision on operability is made. In patients undergoing R0 resection, arterial resection can also be performed.
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: José M
authors.initials: JM
authors.lastname: Alamo
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Luis M
authors.initials: LM
authors.lastname: Marín
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Gonzalo
authors.initials: G
authors.lastname: Suarez
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Carmen
authors.initials: C
authors.lastname: Bernal
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Juan
authors.initials: J
authors.lastname: Serrano
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Lydia
authors.initials: L
authors.lastname: Barrera
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Miguel A
authors.initials: MA
authors.lastname: Gómez
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Jordi
authors.initials: J
authors.lastname: Muntané
authors.affiliation: José M Álamo, Miguel A Gómez, Jordi Muntané, Centro de Investigación Biomédica en Red de Enfermedades Hepáticas y Digestivas (CIBEREH o Ciberehd), Instituto de Salud Carlos III, 28029 Madrid, Spain.
authors.forename: Francisco J
authors.initials: FJ
authors.lastname: Padillo
mesh_terms: D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D059186:Chemoradiotherapy, Adjuvant; D004322:Drainage; D006801:Humans; D020360:Neoadjuvant Therapy; D010180:Pancreatectomy / Q000009:adverse effects / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000009:adverse effects / Q000401:mortality; D019990:Perioperative Care; D011183:Postoperative Complications / Q000209:etiology; D018570:Risk Assessment; D012307:Risk Factors; D016896:Treatment Outcome; D014656:Vascular Surgical Procedures
keywords: Neo-adjuvant therapy; Obstructive jaundice; Pancreatic cancer; Preoperative drainage; Vascular resection