Abstract
For a patient with resected pancreatic cancer at the head of the pancreas, the goal of the medical community in the new millennium is a long-term survival rate exceeding 50% at 5 years. This goal can best be achieved with the following formula: accurate staging by improved imaging that includes laparoscopy for selected patients with locally extensive disease using computed tomography; a balanced resection, not too extensive and not too limited; centralized treatment in high-volume centers, which includes not just the surgeons and hospitals, but also the chemotherapy infusion units; and use of an effective adjuvant or neoadjuvant treatment in which toxicity is associated with efficacy. The ideal outcome for the surgeon is delivery of a patient who has been accurately staged to receive the most appropriate treatment in a timely fashion for an effective chemoradiotherapy protocol. To do this, the surgeon should use objective benchmarks of safe pancreatic resection, which involves resecting only enough, achieving low blood loss, and achieving a minimal length of hospital stay. The outcome is a patient who has optimized his or her gastrointestinal, endocrine, and exocrine functions and is ready for adjuvant treatment 6 weeks after resection. Surgery alone is not sufficient.
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Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE (2002) Hospital volume and surgical mortality in the United States. N Engl J Med 346: 1128–1137
Farnell MB, Pearson RK, Sarr MG, DiMagno EP, Burgart LJ, Dahl TR, Foster N, Sargent DJ (2005) A prospective randomized trial comparing standard pancreatoduodenectomy with pancreatoduodenectomy with extended lymphadenectomy in resectable pancreatic head adenocarcinoma. Surgery 138: 618–628
Houbiers JG, Brand A, van de Watering LM, Hermans J, Verwey PJ, Bijnen AB, Pahlplatz P, Eeftinck Schattenkerk M, Wobbes T, de Vries JE (1994) Randomised controlled trial comparing transfusion of leucocyte-depleted or buffy-coat-depleted blood in surgery for colorectal cancer. Lancet 344: 573–578
Ishikawa O, Wada H, Ohigashi H, Doki Y, Yokoyama S, Noura S, Yamada T, Sasaki Y, Imaoka S, Kasugai T, Matsunaga T, Takenaka A, Nakaizumi A (2003) Postoperative cytology for drained fluid from the pancreatic bed after “curative” resection of pancreatic cancers: does it predict both the patient’s prognosis and the site of cancer recurrence? Ann Surg 238: 103–110
Klinkenbijl JH, Jeekel J, Sahmoud T, van Pel R, Couvreur ML, Veenhof CH, Arnaud JP, Gonzalez DG, de Wit LT, Hennipman A, Wils J (1999) Adjuvant radiotherapy and 5-fluorouracil after curative resection of cancer of the pancreas and periampullary region: phase III trial of the EORTC gastrointestinal tract cancer cooperative group. Ann Surg 230: 776–782
Klinkenbijl JH, van der Schelling GP, Hop WC, van Pel R, Bruining HA, Jeekel J (1992) The advantages of pylorus-preserving pancreatoduodenectomy in malignant disease of the pancreas and periampullary region. Ann Surg 216: 142–145
Langley SM, Alexiou C, Bailey DH, Weeden DF (2002) The influence of perioperative blood transfusion on survival after esophageal resection for carcinoma. Ann Thorac Surg 73: 1704–1709
Liu RC, Traverso LW (2005) Diagnostic laparoscopy improves staging of pancreatic cancer deemed locally unresectable by computed tomography. Surg Endosc 19: 638–642
Park SJ, Kim SW, Jang JY, Lee KU, Park YH (2002) Intraoperative transfusion: is it a real prognostic factor of periampullary cancer following pancreatoduodenectomy? World J Surg 26: 487–492
Pedrazzoli S, DiCarlo V, Dionigi R, Mosca F, Pederzoli P, Pasquali C, Kloppel G, Dhaene K, Michelassi F (1998) Standard versus extended lymphadenectomy associated with pancreatoduodenectomy in the surgical treatment of adenocarcinoma of the head of the pancreas: a multicenter, prospective, randomized study. Lymphadenectomy Study Group. Ann Surg 228: 508–517
Picozzi VJ, Kozarek RA, Traverso LW (2003) Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 185: 476–480
Sohn TA, Yeo CJ, Cameron JL, Koniaris L, Kaushal S, Abrams RA, Sauter PK, Coleman J, Hruban RH, Lillemoe KD (2000) Resected adenocarcinoma of the pancreas—616 patients: results, outcomes, and prognostic indicators. J Gastrointest Surg 4: 567–579
Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H (2004) Pylorus-preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 240: 738–745
Traverso LW, Shinchi H, Low DE (2004) Useful benchmarks to evaluate outcomes after esophagectomy and pancreaticoduodenectomy. Am J Surg 187: 604–608
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Traverso, L.W. Pancreatic cancer: surgery alone is not sufficient. Surg Endosc 20 (Suppl 2), S446–S449 (2006). https://doi.org/10.1007/s00464-006-0052-1
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DOI: https://doi.org/10.1007/s00464-006-0052-1