Pancreatic Cancer pp 1507-1521 | Cite as

Evolution of Pancreatic Cancer Surgery

  • Christoph W. Michalski
  • Bing Liu
  • Markus W. Büchler
  • Thilo Hackert
Reference work entry

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.

Keywords

Centralization Multimodal therapy Laparoscopic surgery Robotic surgery Perioperative management Precursor lesions 

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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Copyright information

© Springer Science+Business Media, LLC, part of Springer Nature 2018

Authors and Affiliations

  • Christoph W. Michalski
    • 1
  • Bing Liu
    • 1
  • Markus W. Büchler
    • 2
  • Thilo Hackert
    • 1
  1. 1.Department of General, Visceral and Transplantation SurgeryHeidelberg University HospitalHeidelbergGermany
  2. 2.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

Section editors and affiliations

  • John Neoptolemos
    • 1
  • Raul A. Urrutia
    • 2
  • James L. Abbruzzese
    • 3
  • Markus W. Büchler
    • 4
  • Thilo Hackert
    • 4
  1. 1.Division of Surgery and OncologyUniversity of LiverpoolLiverpoolUK
  2. 2.Mayo Clinic Cancer CenterMayo ClinicRochesterUSA
  3. 3.Duke University Medical CenterDurhamUSA
  4. 4.Department of General, Visceral and Transplantation SurgeryUniversity of HeidelbergHeidelbergGermany

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