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Pancreatic cancer - surgical options

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Author(s): Ingemar Ihse

Journal: Polish Gastroenterology
ISSN 1232-9886

Volume: 16;
Issue: 2;
Start page: 103;
Date: 2009;
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Keywords: pancreatic cancer | surgery | outcome

ABSTRACT
Pancreatic cancer surgery has progressed significantly during recent years and it is still the only treatment alternative with a chance for cure. In this review the pros and cons of the different surgical options are scrutinized. As extended pancreaticoduodenectomy does not improve survival the standard Whipple operation is still routine, preferably done as a pylorus-sparing procedure. RO-resection should be aimed at. On the other hand evidence now states that the outcome after extended left resection for pancreatic cancer is superior to that after standard operation. Also, total pancreatectomy should no longer be generally abandoned as it nowadays, like the Whipple, represents safe surgery. It should, though, be practised in selected cases only. Local excision is not recommended in any periampullary or ampullary cancers whereas central pancreatectomy may be used for small low-grade tumours. Laparoscopic pancreatic surgery is notyet ready for general use as we are still awaiting larger patient series with longer follow-up periods. Among palliative surgical procedures in patients with pancreatic cancer thoracoscopic splanchnicectomy may be a last resort when other pain treatment offers are failing.
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