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Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis

INTRODUCTION

Approximately 46,420 people develop exocrine pancreatic cancer each year in the United States, and almost all are expected to die from their disease [1]. Global, country-specific incidence and mortality rates are available from the World Health Organization Globocan database.

The majority of exocrine pancreatic cancers (85 percent) are adenocarcinomas arising from the ductal epithelium. Surgical resection is the only potentially curative treatment.  

An overview of the surgical management of cancers of the exocrine pancreas will be reviewed here. The clinical manifestations, diagnosis, and surgical and nonsurgical therapy are discussed separately. (See "Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer" and "Surgical resection of lesions of the head of the pancreas" and "Surgical resection of lesions of the body and tail of the pancreas" and "Adjuvant therapy for resected exocrine pancreatic cancer".)

CANDIDATES FOR RESECTION

Surgical resection is the only potentially curative treatment. Unfortunately, because of the late presentation of the disease, only 15 to 20 percent of patients are candidates for pancreatectomy. The prognosis of pancreatic cancer is poor even in those with potentially resectable disease, and despite progress in surgical techniques and adjuvant therapy, the evidence that outcomes are improving over time is equivocal. (See 'Outcomes of pancreaticoduodenectomy' below and "Adjuvant therapy for resected exocrine pancreatic cancer".)

Preoperative imaging evaluation determines candidacy for resection. Radiographic staging and the role of endoscopic ultrasound (EUS) are discussed in detail elsewhere. (See "Clinical manifestations, diagnosis, and staging of exocrine pancreatic cancer", section on 'Imaging studies' and "Endoscopic ultrasound in the staging of exocrine pancreatic cancer".)

                   

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Literature review current through: Oct 2014. | This topic last updated: Nov 19, 2014.
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