Optimizing The Outcomes Of Pancreatic Cancer Surgery
Oliver Strobel, John P Neoptolemos, Dirk Jaeger, Markus W. Büchler
Published 2018 · Medicine
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Pancreatic cancer is likely to become the second most frequent cause of cancer-associated mortality within the next decade. Surgical resection with adjuvant systemic chemotherapy currently provides the only chance of long-term survival. However, only 10–20% of patients with pancreatic cancer are diagnosed with localized, surgically resectable disease. The majority of patients present with metastatic disease and are not candidates for surgery, while surgery remains underused even in those with resectable disease owing to historical concerns regarding safety and efficacy. However, advances made over the past decade in the safety and efficacy of surgery have resulted in perioperative mortality of around 3% and 5-year survival approaching 30% after resection and adjuvant chemotherapy. Furthermore, owing to advances in both surgical techniques and systemic chemotherapy, the indications for resection have been extended to include locally advanced tumours. Many aspects of pancreatic cancer surgery, such as the management of postoperative morbidities, sequencing of resection and systemic therapy, and use of neoadjuvant therapy followed by resection for tumours previously considered unresectable, are rapidly evolving. In this Review, we summarize the current status of and new developments in pancreatic cancer surgery, while highlighting the most important research questions for attempts to further optimize outcomes.Successful surgical resection offers patients with pancreatic cancer the best chance of survival. However, many patients do not have surgically resectable disease. In this Review, the authors describe recent improvements in pancreatic cancer surgery, which have increased survival and also enabled more patients to undergo surgery.Key pointsSurgical resection in combination with systemic chemotherapy offers the only hope for long-term survival or cure in patients with nonmetastatic pancreatic cancer.Surgical resection and adjuvant multi-agent chemotherapy (gemcitabine plus capecitabine or modified FOLFIRINOX) is the standard of care in patients with resectable pancreatic cancer.Both the safety and efficacy of pancreatic cancer surgery have improved considerably in the past decade, enabling perioperative mortality of around 3% and 5-year survival approaching 30–40% after resection and chemotherapy.Important criteria for assessing the quality of pancreatic cancer surgery include perioperative morbidity and mortality, oncologically determined pancreatic resection, the proportion of patients in fact receiving and completing adjuvant therapy and — above all — long-term survival.Relationships between hospital pancreatectomy volume and outcome quality have an important role in determining the success of pancreatic cancer surgery.Owing to advances in both surgery and systemic chemotherapy, the indications for surgical resections have been extended from stage I and II to locally advanced, previously unresectable pancreatic cancer.
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