Pancreatic Cancer: Surgical Therapy

Localized, or non-metastatic, pancreatic cancer is divided into:

  • Primarily resectable tumor → in this case, RO resection (removal of the tumor in healthy tissue; no tumor tissue is detectable in the resection margin on histopathology) and cure are possible
  • Borderline or borderline resectable tumor (here: infiltration of the portal vein and/or superior mesenteric vein).
  • Locally advanced tumor → attempt of downsizing by neoadjuvant chemotherapy (NACT; to reduce tumor mass prior to surgical intervention); secondary resectability (“surgical removability”) currently succeeds in about 25% of cases.

For pancreatic cancer, the following surgeries can be performed, depending on the stage of the disease:

  • Partial duodenopancreatectomy (partial removal of the pancreas (pancreas) along with the duodenum (duodenum)) with/without pylorus preservation (gastric pylorus preservation) – for pancreatic head carcinomaOperation according to Kausch-Whipple (short: Whipple-Op. ): duodenopancreatectomy (pancreatic head and duodenum/duodenum) + gallbladder + distal bile duct + gastric antrum (right, lower part of the stomach, left of the pylorus) + resection of regional lymph nodes.
  • Subtotal pancreatic left resection, complete duodenopancreatectomy if necessary – for pancreatic corpus tumor and pancreatic tail tumor (depending on the extent).
  • Complete pancreatectomy – for extensive tumors.
  • Palliative operations such as biliodigestive anastomosis (surgically produced anastomosis (connection) between the gallbladder (vesica biliaris) or the ductus choledochus (bile duct) and parts of the gastrointestinal tract to remedy outflow obstruction of bile/for jaundice/ jaundice) or gastroenterostomy (surgical connection of the stomach and small intestine; for gastric outlet stenosis) or a combination of both procedures

Mortality rates (death rate) after pancreatic surgery:

  • Proximal pancreatectomy: mortalities of 2.5% and 4.1%.
  • Distal pancreatectomies 7.3%.
  • Total pancreatectomies 22.9%
  • All-cause in-hospital mortality was 10.1%; more than 6 blood units in 20% of cases; relaparotomy (reopening of the abdomen surgically after laparotomy performed shortly before) in 16% of cases

Further notes

  • Fine-needle aspiration biopsy (examination using a hollow needle to obtain cells/tissues) appears to be a safe diagnostic procedure for evaluating suspicious pancreatic lesions.
  • Resection (surgical removal) of at least 10 regional lymph nodes should always be performed, but not extended lymphadenectomy. Note: Even after a surgical R0 resection (removal of the tumor in healthy; in the histopathology no tumor tissue is detectable in the resection margin), most patients develop recurrences (recurrence of the disease) or metastases (daughter tumors).
  • If distant metastases (organ metastases, peritoneal carcinomatosis, lymph node metastases considered distant metastases) are detected, resection of pancreatic cancer should be omitted.
  • Increasingly, pancreatic surgery is performed as laparoscopic surgery (pancreatic left resection; pancreatic head resection); also for malignant (malignant) tumors. Pancreatic fistulas occur with similar frequency as in conventional surgery. The lethality (mortality) was 1.3%.