The future of surgery for pancreatic cancer

Carcinoma of the pancreas has a grim prognosis even following surgical rese ction. Only a relatively small proportion of patients have a resectable tum our at presentation. At the present time it is uncertain whether the use of radical forms of surgery, or adjuvant therapy improve survival. It is howe ver unlikely that either of these approaches will greatly increase the numb er of long term survivors. Earlier diagnosis particularly in individuals wh o are at greater risk of developing carcinoma of the pancreas is one way in which results might be improved. Unfortunately current imaging techniques are inadequate for the diagnosis of early disease. New molecular diagnostic s techniques that can identify example mutations in oncogenes such as K-ras or deletions of tumour suppressor genes such as P53 or P16 are being devel oped. These tumour specific abnormalities are also a target for gene therap y. Surgery alone cannot cure any patient with pancreatic cancer but may in the future in conjunction with these new approaches.