RESECTION OF PANCREATIC-CANCER - SURGICAL ACHIEVEMENTS

Introduction: Looking back at the initially dismal record for pancreat ic cancer surgery - Whipple himself felt that a 30-35% mortality was j ustifiable (!)-significant progress has been made. Progress: The opera tive mortality has fallen below 5% and the serious complications of pa ncretic resections such as leaks and haemorrhage have been reduced to some 10% and we are better equipped to deal with these if they occur. The 5-year-survival of patients in whom pancreatic cancer was amenable to an RO-resection has risen to 30%. These are the surgical achieveme nts using the standard Kausch-Whipple technique alone. There has been no improvement in these results, either by increasing radicality (regi onal pancreatectomy) or by reducing it (pylorus-preserving pancreatodu odenectomy). The same can be said of all other modalities of oncologic al treatment that have been tried so far: adjuvant radiochemotherapy, regional chemotherapy, hormonal or genetic manipulations. Perspective: This does not mean that we should reduce efforts at improving early d etection of the disease and unravelling its complex molecular biology. On the contrary, the results of surgery alone in spite of all improve ments seem to have reached a plateau that gives little cause for compl acency.