Surgical Extent and Types in Pancreatic Cancer

Kim, Song Cheol

Abstract

Pancreatic cancer continues to pose a major problematic concerns of all forms of gastrointestinal malignancy because of its worst survival. Although the progressions were made in surgical treatment in terms of increasing resection rate and decreasing treatment related morbidity and mortality, the true survival rate remains below 3% today. Surgical options for surgrcal extent and types in pancreas cancer are based on its unique anatomy and physiology, catastrophic tumor biology, experience of surgeon, and status of patients or pancreas. Four main options exist for surgical extent and types in pancreas cancer. They include standard 'Whipple' pancreaticoduodenectomy (PD), pylorus preserving PD, distal pancreatectomy (left side pancreatectomy), and total pancreatectomy. Portal vein involvement with tumor is regarded as a anatomical extension of disease, and en bloc resection of portal vein with tumor is recommended if it is feasible technically, which is shown up in 2002 AJCC tumor staging for pancreas cancer. Comparing the survival times after standard and extended resection of pancreas head cancer no significant survival benefits demonstrated from the retro and prospective reports. PPPD may be superior to standard PD in respect to outcomes of nutrition and quality of life without any deleterious effect of long term survival or recurrence. Conclusively, in the future, multicenter prospective randomized trail should be carried out to clarify the effect of various options and to improve the survival times on th basis of standardization of surgical technique and evidence based data.