Surgery for pancreatic cancer: current controversies and challenges

Monish Karunakaran, Savio George Barreto

Research output: Contribution to journalReview articlepeer-review

Abstract

Two areas that remain the focus of improvement in pancreatic cancer include high post-operative morbidity and inability to uniformly translate surgical success into long-term survival. This narrative review addresses specific aspects of pancreatic cancer surgery, including neoadjuvant therapy, vascular resections, extended pancreatectomy, extent of lymphadenectomy and current status of minimally invasive surgery. R0 resection confers longer disease-free survival and overall survival. Vascular and adjacent organ resections should be undertaken after neoadjuvant therapy, only if R0 resection can be ensured based on high-quality preoperative imaging, and that too, with acceptable post-operative morbidity. Extended lymphadenectomy does not offer any advantage over standard lymphadenectomy. Although minimally invasive distal pancreatectomies offers some short-term benefits over open distal pancreatectomy, safety remains a concern with minimally invasive pancreatoduodenectomy. Strict adherence to principles and judicious utilization of surgery within a multimodality framework is the way forward.

Original languageEnglish
Pages (from-to)5135-5162
Number of pages28
JournalFuture Oncology
Volume17
Issue number36
DOIs
Publication statusPublished - Dec 2021

Keywords

  • extended pancreatectomy
  • lymphadenectomy
  • minimally invasive pancreatic surgery
  • neoadjuvant therapy
  • pancreatic cancer
  • vascular resections

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