Abstract

Surgical options and approaches to pancreatic cancer are changing in the current era. Neoadjuvant treatment strategies for pancreatic cancer combined with the increased use of minimal access surgical techniques mean that the modern pancreatic surgeon requires mastering a number of surgical approaches with to optimally manage patients. Whilst traditional open surgery remains the most frequent approach for surgery, the specific steps during surgery may need to be modified in light of the aforementioned neoadjuvant treatments. Robotic and laparoscopic approaches to pancreatic resection are feasible, but these surgical methods remain in their infancy. In this review article, we summarise the current surgical approaches to pancreatic cancer and how these are adapted to the minimal access setting with discussion of the patient outcome data.

Highlights

  • Pancreatic adenocarcinoma (PDAC) is one of the leading causes of death with 432,242 deaths per year and 458,918 new cases recorded per year according to GLOBOCAN 2018 [1]

  • Surgical resection is the only treatment option that offers the prospect of long-term remission; only approximately 20% of those patients presenting PDAC are eligible for resection [3]

  • Despite this progress in improving patient outcome following surgery for PDAC, the modern pancreatic surgeon is faced with a number of new challenges that can involve modifications to the traditional surgical approach

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Summary

Introduction

Pancreatic adenocarcinoma (PDAC) is one of the leading causes of death with 432,242 deaths per year and 458,918 new cases recorded per year according to GLOBOCAN 2018 [1]. Surgery for PDAC has evolved since Allen Whipple reported the first surgical series in 1935 [4] with recent studies reporting an improved 5-year survival of 30% [5] Despite this progress in improving patient outcome following surgery for PDAC, the modern pancreatic surgeon is faced with a number of new challenges that can involve modifications to the traditional surgical approach. These include the advent of neoadjuvant regimens to PDAC such as those in the current ESPAC-5 trial [6].

Current Era of Pancreatic Surgery for PDAC
Open Pancreatic Surgery with No Vascular Involvement
Artery-First Approach to Pancreatic Resection
Pancreatic Resection in the Presence of Vascular Involvement
Minimally Invasive Pancreatic Resections for PDAC
Minimally Invasive PPPD with Vascular Involvement
Findings
Summary
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