Overview of surgery in the treatment of exocrine pancreatic cancer and prognosis
- Carlos Fernandez-del Castillo, MD
Carlos Fernandez-del Castillo, MD
- Professor of Surgery
- Harvard Medical School
- Ramon E Jimenez, MD
Ramon E Jimenez, MD
- Assistant Professor of Surgery
- University of Connecticut Medical School
- Michael L Steer, MD
Michael L Steer, MD
- Professor of Surgery
- Tufts University School of Medicine
- Section Editors
- Stanley W Ashley, MD
Stanley W Ashley, MD
- Section Editor — Pancreatic and Hepatobiliary Surgery
- Chief Medical Officer and Senior Vice President for Clinical Affairs
- Brigham and Women’s Hospital
- Frank Sawyer Professor of Surgery
- Harvard Medical School
- Kenneth K Tanabe, MD
Kenneth K Tanabe, MD
- Section Editor — Gastrointestinal Malignancies
- Professor of Surgery
- Harvard Medical School
Approximately 53,070 people develop exocrine pancreatic cancer each year in the United States, and almost all are expected to die from their disease . 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".)
However, in a study of the National Cancer Database, among those who were candidates for resection of pancreatic cancer, 38 percent were not offered surgery . Underutilization of surgery for early stage pancreatic cancer may be related to socioeconomic factors as well as physician pessimism regarding the prognosis of the disease.
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- CANDIDATES FOR RESECTION
- PREOPERATIVE CONSIDERATIONS
- Staging laparoscopy
- Role of preoperative biliary drainage
- TUMORS IN THE HEAD OF THE PANCREAS
- - Vascular resection
- - Regional pancreatectomy
- - Extent of lymphadenectomy
- Outcomes of pancreaticoduodenectomy
- TUMORS IN THE BODY OR TAIL
- Outcomes of distal pancreas resection
- TUMORS INVOLVING THE ENTIRE GLAND
- PROGNOSIS AND PROGNOSTIC FACTORS
- INFORMATION FOR PATIENTS
- SUMMARY AND RECOMMENDATIONS
- Tumors in the head/uncinate process
- Tumors of the tail/body
- Tumors involving the entire gland