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Evolution of Pancreatic Cancer Surgery

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Pancreatic Cancer

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Abstract

Pancreatic cancer surgery has undergone considerable changes during the last decades. While it has been associated with high morbidity and mortality in the 1970s and 1980s, improvements in preoperative diagnosis, perioperative management and surgical techniques have made pancreatic resections highly standardized, safe procedures. Centralization of pancreatic surgery at high volume hospitals has contributed significantly to these developments. In particular, the development of interventional radiology has allowed for non-operative management of complications after pancreatic surgery. Further improvements may be achieved through minimally-invasive approaches using laparoscopy and/or robotic resections. Milestones in long term outcome improvement were the studies of the ESPAC group which demonstrated that adjuvant chemotherapy is highly beneficial for all pancreatic cancer patients, regardless of their tumor stage. The latest ESPAC study demonstrated further improved outcomes with simple adjuvant treatment through a combination of gemcitabine and capecitabine. There has also been exciting progress in the therapy of borderline resectable pancreatic cancer. Neoadjuvant protocols using Folfirinox chemotherapy with or without sequential chemoradiation showed promising response and resection rates. Future studies will assess novel approaches in prevention of postoperative pancreatic fistula rates, in more intensive multimodality treatment and in early diagnosis to improve prognosis.

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Abbreviations

DGE:

Delayed gastric emptying

DP:

Distal pancreatectomy

ESPAC:

European Study Group for Pancreatic Cancer

HPB:

Hepato-pancreato-biliary

PD:

Pancreato-duodenenctomy

PDAC:

Pancreatic ductal adenocarcinoma

PF:

Pancreatic fistula

RCT:

Randomized controlled trial

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Author information

Authors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, Heidelberg University Hospital, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Christoph W. Michalski, Bing Liu & Thilo Hackert

  2. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

    Markus W. Büchler

Authors
  1. Christoph W. Michalski
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  2. Bing Liu
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  3. Markus W. Büchler
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  4. Thilo Hackert
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Corresponding author

Correspondence to Christoph W. Michalski .

Editor information

Editors and Affiliations

  1. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    John P. Neoptolemos

  2. Division of Research Department of Surgery and Genomic Sciences and Precision Medicine Center (GSPMC), Medical College of Wisconsin, Milwaukee, Wisconsin, USA

    Raul Urrutia

  3. Division of Medical Oncology, Duke Cancer Institute, Duke University Medical Center, Durham, North Carolina, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Heidelberg, Germany

    Markus W. Büchler

Section Editor information

  1. Division of Surgery and Oncology, University of Liverpool, Daulby Street, Liverpool, UK

    John Neoptolemos

  2. Mayo Clinic Cancer Center, Mayo Clinic, 200 First Street SW, 55905, Rochester, MN, USA

    Raul A. Urrutia

  3. Duke University Medical Center, Durham, NC, USA

    James L. Abbruzzese

  4. Department of General, Visceral and Transplantation Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120, Heidelberg, Germany

     & Markus W. Büchler & Thilo Hackert

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Michalski, C.W., Liu, B., Büchler, M.W., Hackert, T. (2018). Evolution of Pancreatic Cancer Surgery. In: Neoptolemos, J., Urrutia, R., Abbruzzese, J., Büchler, M. (eds) Pancreatic Cancer. Springer, New York, NY. https://doi.org/10.1007/978-1-4939-7193-0_64

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