STATE-OF-THE-ART REVIEW Surgical management of pancreatic cancer

Pancreatic cancer is one of the top 10 cancers in terms of incidence, and continues to be associated with poor 5-year survival. Surgery for localized disease provides the best treatment option with potential for cure. This article discusses pre-operative management, and the evidence for and against biliary drainage prior to surgery, indications for the different types of pancreatic resections and variations in surgery based on evolution of techniques over time, including the extent of lymphadenectomy. The diverse options for reconstruction and their merits are highlighted and the evidence for and against post-operative drainage is presented. Aspects of perioperative management are discussed, with emphasis on complications specific to pancreatic surgery, the role for enhanced recovery and use of somatostatin analogues. The evidence for centralization is outlined, and measures to improve outcomes following these complex resections are detailed.