Preface

I am privileged to host this special edition of the Indian Journal of Surgery on “Contemporary Issues in Pancreatic Surgery,” a challenging topic. The pancreas is a potentially fatal organ posing as an innocuous gland buried deep in the retroperitoneum. When afflicted with disease, it causes severe misery and may at times prove life threatening. As knowledge is rapidly increasing overall, it is difficult to keep oneself abreast with new insights in every field of medicine. This, however, will be best done if one evolves an interest in a specific field and strives to excel in it.

I have been fortunate to work with pancreatic satraps such as Prof. Markus Büchler and Prof. Hackert of the Department of General, Visceral and Transplantation Surgery, Heidelberg. It is a pleasure to watch Prof. Büchler’s deft, bold, and exploring hand during pancreatic surgery. Truly, the operating room loses its command and charm if the “Professor” is not there! His contribution in this issue is an academically rich treatise on vascular resections in pancreatic cancer.

I had some most memorable moments in the operating room with Prof. John L. Cameron, Dr. Christopher Wolfgang, and Dr. Weiss at the Johns Hopkins Hospital, Baltimore. Prof. Cameron is a legend in the field of pancreatic cancer and is credited with over 2000 Whipple operations. His energy and wit are very infectious and motivating. I feel honored that he has contributed the foreword to this issue. This pancreatic group from the Johns Hopkins Hospital discusses ways to reduce serious post-pancreatectomy complications such as pancreatic fistula and delayed gastric emptying.

The influence of Prof. Richard Schulick and Dr. Edil Barish of the University of Colorado, Denver, has helped me to understand the emerging role of minimally invasive pancreatic surgery. Prof. Schulick has some very good organization skills and tremendous positive and progressive outlook and is yet so humble. He is a capacity builder for the young learners. His contribution on neuroendocrine tumors is not only well written but also very easy to grasp.

Prof. Claudio Bassi from the University of Verona Hospital Trust, Italy, needs no introduction for he is known over the world for his work and scientific activity that is fully dedicated to pancreatology. In this issue, he and his colleagues talk about the cystic neoplasms of the pancreas and make it appear a simple problem.

Prof. Peter Allen from the Memorial Sloan Kettering Cancer Centre, New York, is one surgeon whom all pancreatic surgeons must observe to appreciate the ease with which he handles the pancreas, removing it (Whipple operation) in just 2 hours and without blood transfusion. With the same dexterity, he does vascular resections in no time. In this issue, you will enjoy reading his crisp commentary on whether to operate or to observe cystic neoplasms of the pancreas, a topic he excels in.

I had a rich experience at the MD Anderson Cancer Centre, Houston, under Dr. Jason Fleming and Dr. M.H. Katz, and there, I briefly met Dr. Gauri Varadhachary, Professor of Medical Oncology, during the Pancreas Cancer Multidisciplinary Conference. She has to her credit the landmark publication for the entity we know today as the “Borderline Resectable Pancreatic Cancer.” She has summarized this difficult topic succinctly in the present issue for our advantage.

Although I have never worked with Prof. Dilip Parekh from Keck School of Medicine, LA, and Prof. John Windsor from University of Auckland, surgeons and academicians par excellence, I am grateful that they agreed to write for our journal and have contributed some of the best illustrative articles in this issue on surgical aspects of chronic and acute pancreatitis respectively.

I am especially happy to introduce Prof. Amitabh Gautam, who is a transplant surgeon at the Boston University School of Medicine and an avid marathon runner. He has been my teacher during my General Surgery residency. His brief to-the-point expert comment on islet cell transplantation for patients with chronic pancreatitis is extremely interesting to read.

This issue would be incomplete without inputs from the two most famous and foremost pancreatic surgeons of our country, Prof. Adarsh Chaudhary from Medanta, New Delhi, and Prof. Shailesh Shrikhande from Tata Memorial Hospital, Mumbai. Prof. Shrikhande’s article throws light on the basics of surgery for pancreatic and periampullary carcinoma, and Prof. Adarsh analyzes the overall impact of the present known strategies for combating pancreatic and periampullary cancer on the ultimate goal of improving patients’ survival.

My colleagues Dr. Prabin Thapa from Kathmandu Medical College Teaching Hospital, Nepal, and Dr. Ashish Verma from my Institute discuss the present knowledge about the epidemiology and preoperative staging of pancreatic and periampullary cancer respectively.

Prof. William Jarnagin, Chief, Hepatopancreatobiliary Service, Memorial Sloan Kettering Cancer Centre (MSKCC), New York, was very supportive and discussed at length on various issues of HPB surgery during the time I was a fellow with him. I specially enjoyed the multidisciplinary meetings at MSKCC that he chaired and the classes of Prof. Leslie H. Blumgart. I am so grateful to him for approving my introductory article of this issue.

Prof. Micheal Kendrick from the Mayo Clinic, Rochester is an extraordinarily skilled laparoscopic HPB surgeon with a sharp and an innovative mind. He is credited to having performed complex venous resections and reconstructions during totally laparoscopic pancreaticoduodenectomy. The article on Laparoscopic Pancreatic Resections for Cancer summarizes some of his best contributions to the field with his surgical tips. 

Prof. Roland S Croner from Erlangen, Germany has a deep interest in robotic HPB surgery and in developing robotic programs in hospitals. He has beautifully discussed the feasibility and advantages of robotic pancreatic resection in this special issue.

I express my deepest gratitude to my mentor Prof. Hari S Shukla, Distinguished Professor, Banaras Hindu University, and to Prof. Adarsh Chaudhary, Medanta, New Delhi, for helping me with the peer review of the manuscripts.

Last but not the least, I thank the Indian Journal of Surgery administration for giving me the opportunity to host this present issue as the Guest Editor.

Happy reading!