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World J Gastroenterol. Jun 28, 2012; 18(24): 3058-3069
Published online Jun 28, 2012. doi: 10.3748/wjg.v18.i24.3058
Ductal adenocarcinoma of the pancreatic head: A focus on current diagnostic and surgical concepts
Mehdi Ouaïssi, Urs Giger, Guillaume Louis, Igor Sielezneff, Olivier Farges, Bernard Sastre
Mehdi Ouaïssi, Guillaume Louis, Igor Sielezneff, Bernard Sastre, Centre for Research in Oncology and Oncopharmacologie, Aix Marseille University, 13005 Marseille, France
Mehdi Ouaïssi, Igor Sielezneff, Bernard Sastre, Department of Oncologic and Digestive Surgery, Timone Hospital, 13385 Marseille, France
Urs Giger, Department of Surgery, Marienhospital Herne, Ruhr University Bochum, 44625 Herne, Germany
Guillaume Louis, Department of Radiology, Timone Hospital, 13385 Marseille, France
Olivier Farges, Department of Hepato-Biliary Surgery, Beaujon Hospital, 92110 Clichy, France
Author contributions: Ouaïssi M and Giger U contributed equally to this paper; Ouaïssi M and Giger U designed and conceived the study and participated in analysis and interpretation; they drafted the manuscript, participated in administrative, technical and material support; Ouaïssi M and Louis G acquired data; Sielezneff I, Sastre B and Farges O contributed to supervision and critical review of the manuscript.
Correspondence to: Mehdi Ouaïssi, MD, PhD, Department of Oncologic and Digestive Surgery, Timone Hospital, 264 rue Saint-Pierre,13385 Marseille, France. mehdi.ouaissi@mail;
Telephone: +33-491-385852 Fax: +33-491-385552
Received: July 7, 2011
Revised: December 13, 2011
Accepted: April 28, 2012
Published online: June 28, 2012

Complete surgical resection still remains the only possibility of curing pancreatic cancer, however, only 10% of patients undergo curative surgery. Pancreatic resection currently remains the only method of curing patients, and has a 5-year overall survival rate between 7%-34% compared to a median survival of 3-11 mo for unresected cancer. Pancreatic surgery is a technically demanding procedure requiring highly standardized surgical techniques. Nevertheless, even in experienced hands, perioperative morbidity rates (delayed gastric emptying, pancreatic fistula etc.) are as high as 50%. Different strategies to reduce postoperative morbidity, such as different techniques of gastroenteric reconstruction (pancreatico-jejunostomy vs pancreatico-gastrostomy), intraoperative placement of a pancreatic main duct stent or temporary sealing of the main pancreatic duct with fibrin glue have not led to a significant improvement in clinical outcome. The perioperative application of somatostatin or its analogues may decrease the incidence of pancreatic fistulas in cases with soft pancreatic tissue and a small main pancreatic duct (< 3 mm). The positive effects of external pancreatic main duct drainage and antecolic gastrointestinal reconstruction have been observed to decrease the rate of pancreatic fistulas and delayed gastric emptying, respectively. Currently, the concept of extended radical lymphadenectomy has been found to be associated with higher perioperative morbidity, but without any positive impact on overall survival. However, there is growing evidence that portal vein resections can be performed with acceptable low perioperative morbidity and mortality but does not achieve a cure.

Keywords: Pancreatic adenocarcinoma, Pancreatic fistula, Pancreatic surgery, Venous resection