Surgical Treatment of Pancreatic Cancer

Abstract
The nihilistic position adapted by many surgeons to the effect that the diagnosis of cancer of the pancreas presents a contraindication for a tumor resection is obsolete today. The early resection, especially of smaller tumors, is today considered to be the only therapeutic means of restituting the patient. 5-year survival rates of up to 30% following tumor resections and adjuvant treatment, mainly reported from Japan, underline this point of view. In order to be able to further improve the prognosis of patients with cancer of the pancreas, an aggressive diagnosis is required. In the event of epigastric complaints of unknown origin, the possibility of pancreatic carcinomas should always be excluded by means of an ERCP after any other epigastric causes were investigated. The 90% sensitivity of the ERCP makes it possible to diagnose small pancreatic tumors at an early stage and to subject the patient to an early curative resection. Pancreatic tumors have to be resected radically and safely, that is with a low perioperative morbidity and mortality. The figures obtained from the literature stress that a pancreatic resection in the case of a carcinoma can be carried out with a perioperative mortality of below 5%. Irrespective of the surgical treatment method, patients with cancer of the pancreas ought to be included in adjuvant therapy studies. Monocenter and/or multicenter studies ought to be able to work out new adjuvant therapeutic strategies which may help in future to improve the prognosis of cancer of the pancreas.