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

Carlos Fernandez-del Castillo, MD
Ramon E Jimenez, MD
Section Editors
Stanley W Ashley, MD
Kenneth K Tanabe, MD
Deputy Editors
Wenliang Chen, MD, PhD
Diane MF Savarese, MD


Approximately 53,670 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 "Treatment for potentially resectable exocrine pancreatic cancer".)


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 "Treatment for potentially resectable 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 [2]. 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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Literature review current through: Nov 2017. | This topic last updated: Mar 27, 2017.
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