Radical surgery for adenocarcinoma of body and tail of pancreas: current status and future perspectives

Abstract

Radical resection is crucial in the surgical treatment of adenocarcinoma of the body and tail of pancreas. It usually refers to negative resection margin and dissection of regional lymph nodes. In recent reports, the definition of R0 margin has been updated, and radical antegrade modular pancreatosplenectomy (RAMPS), which was first described by Strasberg et al, contributes to achieving negative tangential margins. In some cases, extended radical resections were adopted in an attempt to achieve R0 margin. However, it would increase operation related morbidity and mortality, which should be taken into account before the procedure. Lymph nodes metastasis is an important prognostic factor. Extended lymph nodes dissection does not seem to bring survival benefits, while it's helpful in assessing the tumor stages and patients' prognosis. Laparoscopic distal pancreatectomy (LDP) has been applied in the treatment of ductal adenocarcinoma of the pancreas in reports with small sample sizes. But it remains controversial whether LDP is superior comparing to conventional open methods in regards to oncological outcomes. Curently, surgery is the promising method that may cure adenocarcinoma of the body and tail of pancreas. Highlighting radical resection will bring more survival benefits to patients. Key words: Adenocarcinoma of the body and tail of pancreas; Radical surgery; Laparoscopy