Pancreatic cancer - Surgical progress and future management

Purpose: Deaths from pancreatic ductal adenocarcinoma rank fourth among cancer-related mortality in the United States. Curative resection is the single most important factor determining survival in patients with pancreatic adenocarcinoma. This review explores the surgical management of pancreatic adenocarcinoma, with attention to pre-operative staging, operative strategies, and future experimental approaches. Methods: A computerized search was made of the Medline database from January 1970 to June 2012 using keywords related to pancreatic adenocarcinoma ('pancreatic ductal adenocarcinoma' or 'pancreatic adenocarcinoma' or 'pancreatic cancer'). References from all articles retrieved were subsequently studied for any additional articles. Letters, reviews without original data, and non-English language articles were excluded. Studies were assessed for results specific to pancreatic adenocarcinoma. All other histological types of pancreatic cancer were excluded. Conclusion: Pancreatic ductal adenocarcinoma is a major oncologic burden with poor prognosis despite multi-modality therapy. Improvements in surgical strategies have expanded the degree of resectable cases. Despite improved perioperative outcomes over the last three decades, there remains poor long-term survival for both surgical and non-surgical patients. Continued collaboration between surgical oncologists, medical and radiation oncologists, and research scientists will improve cure rates and overall survival for affected patients.