title: Challenges in pancreatic adenocarcinoma surgery - National survey and current practice guidelines.
abstract: BACKGROUND
  Pancreatic ductal adenocarcinoma (PDAC) remains one of the most deadly cancers in Europe and the USA. There is consensus that radical tumor surgery is the only viable option for any long-term survival in patients with PDAC. So far, limited data are available regarding the routine surgical management of patients with advanced PDAC in the light of surgical guidelines.
  
  
  METHODS
  A national survey on perioperative management of patients with PDAC and currently applied criteria on their tumor resectability in German university and community hospitals was carried out.
  
  
  RESULTS
  With a response rate of 81.6% (231/283) a total of 95 (41.1%) participating departments practicing pancreatic surgery in Germany are certified as competence and reference centers for surgical diseases of the pancreas in 2016. More than 95% of them indicate to carry out structured and interdisciplinary therapies along with an interdisciplinary pre- and postoperative tumor board. The majority of survey respondents prefer the pylorus-preserving partial pancreatoduodenectomy (93.1%) with standard lymphadenectomy for cancer of the pancreatic head. Intraoperative histological evaluation of the resection margins is used regularly by 99% of the survey respondents. 98.7% of survey respondents carry out partial or complete vein resection, 126 respondents (54.5%) would resect tumor adjacent arteries, and 102 respondents (44.2%) would perform metastasectomy if complete PDAC resection (R0) is possible.
  
  
  CONCLUSIONS
  Evidence-based and standardized pancreatic surgery is practiced by a large number of hospitals in Germany. However, a significant number of survey respondents support an extended radical tumor resection in patients with advanced PDAC even when not indicated by current clinical guidelines.
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Sameer A
authors.initials: SA
authors.lastname: Dhayat
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Philip
authors.initials: P
authors.lastname: Mirgorod
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Christina
authors.initials: C
authors.lastname: Lenschow
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Norbert
authors.initials: N
authors.lastname: Senninger
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Christoph
authors.initials: C
authors.lastname: Anthoni
authors.affiliation: Department of General and Visceral Surgery, University Hospital Muenster, Muenster, Germany.
authors.forename: Thorsten
authors.initials: T
authors.lastname: Vowinkel
mesh_terms: D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery; D000066491:Clinical Decision-Making; D019468:Disease Management; D005858:Germany; D019538:Health Care Surveys; D006764:Hospitals, Community; D006785:Hospitals, University; D006801:Humans; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D017410:Practice Guidelines as Topic; D011795:Surveys and Questionnaires