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Copyright ©The Author(s) 2019. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastrointest Surg. Mar 27, 2019; 11(3): 143-154
Published online Mar 27, 2019. doi: 10.4240/wjgs.v11.i3.143
Management of pancreatic head adenocarcinoma: From where to where?
Kemal Dolay, Fatma Umit Malya, Sami Akbulut
Kemal Dolay, Department of Surgery, Division of Hepato-Pancreato-Biliary Surgery, Istinye University, Liv Hospital, Istanbul 34340, Turkey
Fatma Umit Malya, Department of Surgery, Bezmialem Vakif University Faculty of Medicine, Istanbul 34093, Turkey
Sami Akbulut, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Malatya 44280, Turkey
Author contributions: All authors equally contributed to this paper with conception and design of the study, literature review and analysis, drafting and critical revision and editing, and final approval of the final version.
Conflict-of-interest statement: No potential conflicts of interest. No financial support.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Corresponding author: Sami Akbulut, MD, FACS, Associate Professor, Surgeon, Department of Surgery and Liver Transplant Institute, Inonu University Faculty of Medicine, Elazig Yolu 10. Km, Malatya 44280, Turkey. akbulutsami@gmail.com
Telephone: +90-422-3410660 Fax: +90-422-3410676
Received: February 27, 2019
Peer-review started: February 27, 2019
First decision: March 14, 2019
Revised: March 19, 2019
Accepted: March 20, 2019
Article in press: March 20, 2019
Published online: March 27, 2019
Processing time: 28 Days and 21.1 Hours
Abstract

Pancreatic head adenocarcinoma (PHAC) is one of the most aggressive malignancies, and it has low long-term survival rates. Surgery is the only option for long-term survival. The difficulties associated with PHAC include higher frequencies of regional or distant lymph node metastases and vascular involvement, and positive resection margins in pancreatic and retroperitoneal tissues. Radical resections increase margin negativity and life expectancy; however, the extend of the surgery applied is controversial. Thus, western and eastern centers may use different approaches. Multiorgan, peripancreatic nerve plexus, and vascular resections have been discussed in relation to radical surgery for pancreatic cancer as have the roles of neoadjuvant and adjuvant therapy regimens. Determining the appropriate limits for surgery, standardizing definitions and surgical techniques according to guidelines, and centralizing pancreatic surgery within high-volume institutions to reduce mortality and morbidity rates are among the most important issues to consider. In this review, we evaluate the basic concepts underlying and the roles of radical surgery for PHAC, and lymphadenectomy, nerve plexus, retroperitoneal tissue, vascular, and multivisceral resections, total pancreatectomy, and liver metastases are discussed.

Keywords: Pancreatic head cancer; Standard pancreatectomy; Extended pancreatectomy; Regional lymphadenectomy; Extended lymphadenectomy

Core tip: The challenges associated with pancreatic head adenocarcinoma include higher frequencies of regional or distant lymph node metastases and positive resection margins in the pancreatic and retroperitoneal tissues. There is no consensus on whether there is any difference between the standard and extended resections of pancreatic head adenocarcinoma in terms of in-hospital mortality, morbidity, disease free and overall survival. In this study, we aimed to discuss the positive and negative aspects of these two approaches.