Pancreatic cancer is one of the most aggressive tumors arising from digestive system. Traditionally considered of bad prognosis and challenging from the surgeon’s point of view, current advances in surgical technique allow radical approach of pancreatic tumors in safe conditions and with increasingly better outcomes.
Pancreatic cancer is one of the most frequently diagnosed digestive tumors. For a very long time it was considered to have a dismal prognosis, and surgical treatment seemed to be a good therapeutic option, although with high surgical risks. The important progress made in surgical techniques and the wide experience of surgical departments of the field have permitted improving the results of the treatment with this medical procedure.
The specific use of new and promising chemotherapy drugs and the arising of very precise radiotherapeutic techniques (radiosurgery) have contributed to this progress and to good results in our Hospital as well.
The evolution of the pancreatic cancer can be easily established thanks to an adequate diagnosis methodology, the use of ultrasonographies, helical computerized tomographies, nuclear magnetic resonances, positron emission tomographies and laparoscopic ultrasonography. Thus, we can follow and adequate and unique therapeutic strategy for the patient with pancreatic cancer.
There are many prediction factors that influence the evolution of the pancreatic cancer. The most important of them all is obtaining “free margins” in surgery. Because of this, the main aim in surgical treatment for pancreatic cancer must be a total resection of the pancreatic tumor and its different dissemination vias. However, there are different factors that determine the complexity of this surgical technique, such as the morphological characteristics of the pancreas, its anatomic location and, most importantly, the way pancreatic tumors are disseminated.
Our concept of extended surgery in the treatment of pancreatic cancer intends to achieve comprehensive work on the rest of the pancreatic gland in order to treat possible multicentricity.
This is done by resecting the retroperitoneal tissue and the loco-regional lymphatic and perineural lymphatic extension (para-aortic area, celiac axis area and superior mesenteric artery area), as well as the vascular structures (the superior mesenteric vein and, less frequently, the superior mesenteric artery or the hepatic artery) in case they were affected.
In patients with favourable preoperative radiologic tests and no spread disease, this technique unquestionably ensures a complete resection of the pancreatic tumor and prevents hematogenous spread.Nowadays, the functional consequences of this type of surgery (exocrine and endocrine pancreatic failure) can be easily controlled with pancreatic enzymes and new types of insulin.