Overview of Resections for Pancreatic and Periampullary Cancer

Abstract

The relative safety of modern pancreatic and periampullary resections arises from over a century of calculated risk and progress, edged forward by surgeons who challenged the limits of human physiology. Pancreatic surgery has long been technically demanding and with slow and steady advancements. Early pioneers in the late 1800s operated in an era of alarmingly high mortality and morbidity, but each laid the groundwork for the future. This tradition was carried on by Allen Whipple, whose name is synonymous with the most famous pancreatic head resection. His work and publications spurred a generation of interest and propelled the field from a two-stage to a single-stage operation, with improving although still substantial failures. Medical and technologic advancements aided those seeking to improve outcomes. Many of Whipple’s contemporaries and trainees have since refined the modern combination of technical mastery and rescue therapies that have resulted in improved mortality. Morbidity after pancreatic resection remains substantial, and the ideal combination of preoperative therapies, operative conduct, and postoperative management still remains hotly debated in an attempt to further improve outcomes. Yet despite the progress since the early days of pancreatic resections, much more is to be learned and perfected in the century to come.