Editorial
Copyright ©2012 Baishideng. All rights reserved.
World J Gastrointest Surg. May 27, 2012; 4(5): 104-113
Published online May 27, 2012. doi: 10.4240/wjgs.v4.i5.104
Pancreatic adenocarcinoma: Outstanding problems
Olga P Zakharova, Grigory G Karmazanovsky, Viacheslav I Egorov
Olga P Zakharova, Grigory G Karmazanovsky, Department of Radiology, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
Viacheslav I Egorov, Hepatopancreatobiliary Surgery, Vishnevsky Institute of Surgery, 117997 Moscow, Russia
Author contributions: Zakharova OP and Karmazanovsky GG developed the concept and design of the manuscript; Zakharova OP, Karmazanovsky GG and Egorov VI made substantial contributions to acquisition, analysis and interpretation of data; all authors discussed the results and implications, commented on the manuscript at all stages and participated sufficiently in the work; Zakharova OP wrote the main paper, Karmazanovsky GG helped conduct the literature review; Egorov VI reviewed the surgical aspect of the work; Karmazanovsky GG gave final approval of the version to be submitted; all authors contributed extensively to the work presented in this paper.
Correspondence to: Grigory G Karmazanovsky, MD, PhD, Professor, Department of Radiology, Vishnevsky Institute of Surgery, 117997 Moscow, Russia. karmazanovsky@ixv.comcor.ru
Telephone: +7-499-2370454 Fax: +7-499-2370814
Received: March 14, 2011
Revised: May 10, 2012
Accepted: May 18, 2012
Published online: May 27, 2012
Abstract

Pancreatic adenocarcinoma remains the fourth leading cause of cancer-related death and is one of the most aggressive malignant tumors with an overall 5-year survival rate of less than 4%. Surgical resection remains the only potentially curative treatment but is only possible for 15%-20% of patients with pancreatic adenocarcinoma. About 40% of patients have locally advanced nonresectable disease. In the past, determination of pancreatic cancer resectability was made at surgical exploration. The development of modern imaging techniques has allowed preoperative staging of patients. Institutions disagree about the criteria used to classify patients. Vascular invasion in pancreatic cancers plays a very important role in determining treatment and prognosis. There is no evidence-based consensus on the optimal preoperative imaging assessment of patients with suspected pancreatic cancer and a unified definition of borderline resectable pancreatic cancer is also lacking. Thus, there is much room for improvement in all aspects of treatment for pancreatic cancer. Multi-detector computed tomography has been widely accepted as the imaging technique of choice for diagnosing and staging pancreatic cancer. With improved surgical techniques and advanced perioperative management, vascular resection and reconstruction are performed more frequently; patients thought once to be unresectable are undergoing radical surgery. However, when attempting heroic surgery, a realistic approach concerning the patient’s age and health status, probability of recovery after surgery, perioperative morbidity and mortality and life quality after tumor resection is necessary.

Keywords: Pancreatic adenocarcinoma, Multidetector computed tomography, Borderline resectability, Neoadjuvant therapy, Pancreaticoduodenectomy, Vascular resection