Abstract
Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics.
Highlights
Various pancreatic diseases demand surgery, among which malignant tumor resection is the mainstay of pancreatic surgery, including local, partial, or total pancreatectomy
In control studies by Sasson et al and Shoup et al patient survival after extended distal pancreatectomy (DP) and standard DP showed no significant difference (26 months vs. 16 months; p = 0.08) [29,34], indicating that by applying an extended DP a similar long-term survival can be achieved when compared to patients suffering from pancreatic cancer without adjacent organ infiltration, a circumstance which is normally considered as a poor indicator
A further argument in favor of Total pancreatectomy (TP) is tumor multicentricity, but this still needs to be clearly elucidated, since in some studies tumor dissemination was reported to occur in more than 30% of cases, which is contrary to other studies with only 0% and 6% [58,59,60,61]
Summary
Various pancreatic diseases demand surgery, among which malignant tumor resection is the mainstay of pancreatic surgery, including local, partial, or total pancreatectomy. Stitzenberg et al reported on 12 out of 252 patients with pancreatic cancer who underwent PD with resection of a tumor-involved hepatic artery and/or celiac artery They showed that arterial resection resulted in a similar median survival time compared to their patients without arterial resection (20 vs 21 months) [25]. In control studies by Sasson et al and Shoup et al patient survival after extended DP (required resection of surrounding structures) and standard DP showed no significant difference (26 months vs 16 months; p = 0.08) [29,34], indicating that by applying an extended DP a similar long-term survival can be achieved when compared to patients suffering from pancreatic cancer without adjacent organ infiltration, a circumstance which is normally considered as a poor indicator. Validation of these advanced procedures by clinical trials is still required [2]
Sign-in/Register to view highlights & summary Sign-in/Register to access full text options 
Talk to us
Join us for a 30 min session where you can share your feedback and ask us any queries you have
Schedule a call
