Surgical treatment of periampullary and pancreatic cancer

Summary   Background: Pancreatic cancer is a common malignancy in the United States with approximately 28,000 cases per year. Two-thirds of these patients will have adenocarcinoma of the pancreas, and for the majority of patients it is a lethal disease. Methods: Current diagnosis and results of surgical and adjuvant treatment options for pancreatic cancer are discussed. Results: Operative mortality has been reduced to <5% in all major centers, and direct correlation of volume with outcome has become established. Preoperative biopsy is not mandatory in our hands. Preoperative biliary drainage has not been shown to be beneficial. Prospective randomized trials of nutritional support following pancreatic resection have shown routine nutritional support to be of no value. Adjuvant treatment trials have shown limited if any benefit following resection for adenocarcinoma of the pancreas. Conclusion: Surgical resection offers the only hope for cure or significant palliation and ensures that patients with more favorable histopathologies are not neglected. Recent advances involve improvement in noninvasive diagnosis and the accurate prediction of resectability so that patients do not undergo unnecessary procedures. Current approaches focus on innovative investigative treatment regimes.