Oncological standard surgery of pancreatic carcinoma

Improvements in pancreatic surgery as well as in intensive care have significantly reduced the postoperative morbidity and letality after resection for pancreatic cancer. Since resection is still the only treatment modality with a chance for cure and at the same time provides the best palliation, it should be offered less restrictive. The classical Whipple procedure as well as the pylorus-preserving resection are considered the standard procedures, and both are performed with systematic dissection of the lymph node regions if curative surgery is intended. Pancreatic anastomosis is performed as a standardized two layer end-to-end pancreatico-jejunostomy with a Y-Roux loop. This technique, combined with the perioperative administration of octreotide, reduced substantially the morbidity and letality alter major pancreatic resections. These improvements decreased the perioperative letality to rates under 5% and increased 5-year survival rates up to 30% in experienced centers. Further improvements in long-term survival may be realized by a combination of standardized resections and adjuvant therapeutic modalities.