title: Surgical resection strategies for locally advanced pancreatic cancer.
abstract: BACKGROUND
  Despite all improvements in tumor diagnostics and treatment, pancreatic cancer is still the fourth leading cause of cancer-related death in the Western world. It is mostly diagnosed at a locally advanced or metastasized stage because of the lack of early symptoms. A radical margin-free surgical resection offers the only potential cure for locoregional disease. Over the last decades, several surgical strategies and techniques have evolved to optimize oncologic radical resections and thus to improve long-term outcome of patients.
  
  
  OBJECTIVE
  The purpose of this review was to describe the various surgical strategies and techniques for locally advanced pancreatic cancer and to evaluate their influence on long-term outcome.
  
  
  CONCLUSIONS
  Locally advanced pancreatic cancer should not generally be deemed unresectable. Various surgical techniques offer a good chance of margin-free tumor resection, even if surrounding organs or vessels are involved. Because of potentially higher peri- and postoperative morbidity rates, patients should be selected properly and are best treated in specialized high-volume centers.
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Alexander
authors.initials: A
authors.lastname: Gluth
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany.
authors.forename: Jens
authors.initials: J
authors.lastname: Werner
authors.affiliation: Department of General, Visceral, Transplantation, Vascular, and Thoracic Surgery, LMU University Hospital, Marchioninistraße 15, 81377, Munich, Germany. werner.hartwig@med.uni-muenchen.de.
authors.forename: Werner
authors.initials: W
authors.lastname: Hartwig
mesh_terms: D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008197:Lymph Node Excision / Q000379:methods / Q000401:mortality; D008198:Lymph Nodes / Q000473:pathology*; D008297:Male; D009361:Neoplasm Invasiveness / Q000473:pathology; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods* / Q000401:mortality; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D016577:Pancreaticoduodenectomy / Q000379:methods / Q000401:mortality; D011379:Prognosis; D018570:Risk Assessment; D013156:Splenectomy / Q000379:methods / Q000401:mortality; D016019:Survival Analysis; D016896:Treatment Outcome
keywords: Extended resection; Pancreas; Resection technique; Surgery