Neoadjuvant and adjuvant therapy in ductal adenocarcinoma of the pancreas

The optimal oncological management of ductal pancreatic cancer remains unde fined. More than 60% of these patients have disseminated disease at the Lim e of presentation. Were radical surgery alone cannot guarantee a cure. Even in the best case of a RO-resection with extended lymph node dissection the reported 5-year survival rates of 20-30% are dissatisfying. This would sug gest that neoadjuvant or adjuvant therapies may play an even greater role i n improving the medium and longterm survival rates than in other tumor enti ties. Reports in the literature to date are from small randomised trials wh ich do not elucidate the benefit of therapy. However, it does appear that n eoadjuvant radiochemotherapy in combination with RO-resection will best imp rove patient outcome and mean survival rates. Therefore there is a need for large prospective randomized studies regarding (neo-)adjuvant therapy. Inc lusion criteria must be precisely defined and the following factors recorde d: standardized preoperative staging procedures extent of tumor disease (histology, stage, vascular infiltration, lymph nod e involvement, etc.) detailed surgical approach in respect to the extent of pancreas resection a nd lymph node dissection. Pancreas resections tend to have a higher postoperative complication rate w hen compared with other tumours and substantial postoperative weight loss o ften is observed. This may result in a delay or even impossibility of start ing adjuvant therapy right in time in a relevant part of patients (up to 1/ 3 according to literature data) which is a major disadvantage of all adjuva nt therapy concepts.