From the Guidelines
Surgical Options for Pancreatic Disorders
The primary surgical options for pancreatic disorders, specifically pancreatic cancer, are radical surgery, which includes partial pancreatico-duodenectomy for tumors in the pancreatic head, distal resection of the pancreas for tumors in the body or tail, and total pancreatectomy in cases where the cancer diffusely involves the pancreas or is present at multiple sites 1.
- Partial pancreatico-duodenectomy, also known as the Whipple procedure, is the treatment of choice for tumors in the pancreatic head, and may involve open or minimally invasive approaches 1.
- Distal pancreatectomy is commonly performed for resectable tumors in the pancreatic tail, and may involve removal of the spleen 1.
- Total pancreatectomy may be required in cases where the cancer is diffuse or multifocal, and involves removal of the entire pancreas, part of the small intestine, a portion of the stomach, the common bile duct, the gallbladder, and nearby lymph nodes 1.
Key Considerations
- Resectability is a critical issue in pancreatic cancer, and is defined by the NCCN criteria, which consider factors such as tumor size, location, and involvement of nearby vessels and organs 1.
- Lymphadenectomy is an important component of surgical management, but extended lymphadenectomy has not been shown to confer a survival advantage, and standard lymphadenectomy is recommended 1.
- Age is not a criterion for selecting patients for surgical approach, but comorbidity can be a reason to abstain from surgery, especially in patients older than 75-80 years 1.
Adjuvant Therapy
- Adjuvant chemotherapy is recommended for patients with resected pancreatic cancer, and may involve 6 months of GEM or 5-FU chemotherapy 1.
- Neoadjuvant therapy is an emerging approach for patients with borderline resectable disease or high-risk features, and may involve chemotherapy, radiation therapy, or chemoradiation 1.
From the Research
Surgical Options for Pancreatic Disorders
The following are some of the surgical options available for pancreatic disorders:
- Pancreatectomy, including pancreaticoduodenectomy (PD), central pancreatectomy (CP), distal pancreatectomy (DP), and total/subtotal pancreatectomy 2
- Local organ-preserving resection techniques, such as enucleation and distal pancreatectomy with or without preserving the spleen 3, 4
- Minimally invasive laparoscopic and robotic surgical techniques for the resection of pancreatic tumors 3, 4
- Pancreatic ductal drainage with pancreaticojejunostomy for patients with a dilated pancreatic duct 5
- Resection for chronic pancreatitis, including pancreaticoduodenectomy, distal pancreatectomy, total pancreatectomy, duodenum-preserving pancreatic head resection (Beger procedure), or local resection of the pancreatic head with longitudinal pancreaticojejunostomy (Frey procedure) 5
Specific Surgical Procedures
Some specific surgical procedures that have been studied include:
- Whipple resection, which is a classic procedure for pancreatic cancer, but may not be the best option for all patients 3
- Pylorus-preserving pancreaticoduodenectomy, which is considered the gold standard resection procedure, but may have some drawbacks 5
- Beger resection and Frey procedure, which are newer operations that may be as effective as pancreaticoduodenectomy in terms of pain relief and better in terms of nutritional repletion and preservation of endocrine and exocrine function 5
Minimally Invasive Surgical Techniques
Minimally invasive surgical techniques, such as laparoscopic and robotic surgery, are being used more frequently for the resection of pancreatic tumors and have seen major progress 3, 4