Pancreatic Surgery: Beyond the Traditional Limits
Pancreatic cancer is one of the five leading causes of cancer death for both males and females in the western world. More than 85 % pancreatic tumors are of ductal origin but the incidence of cystic tumors such as intrapapillary mucinous tumors (IPMN) or
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Open Access
Review
Surgical strategies for treatment of malignant pancreatic tumors: extended, standard or local surgery? Matthias Glanemann*†1, Baomin Shi†1,2, Feng Liang2, Xiao-Gang Sun2, Marcus Bahra1, Dietmar Jacob1, Ulf Neumann1 and Peter Neuhaus1 Address: 1Department of General, Visceral, and Transplantation Surgery, Charité, Campus Virchow Klinikum, Universitätsmedizin Berlin, Germany and 2Department of Hepatobiliary Surgery, Shandong Provincial Hospital, Clinical College of Shandong University, Jinan, PR China Email: Matthias Glanemann* - [email protected]; Baomin Shi - [email protected]; Feng Liang - [email protected]; Xiao-Gang Sun - [email protected]; Marcus Bahra - [email protected]; Dietmar Jacob - [email protected]; Ulf Neumann - [email protected]; Peter Neuhaus - [email protected] * Corresponding author †Equal contributors
Published: 12 November 2008 World Journal of Surgical Oncology 2008, 6:123
doi:10.1186/1477-7819-6-123
Received: 29 July 2008 Accepted: 12 November 2008
This article is available from: http://www.wjso.com/content/6/1/123 © 2008 Glanemann et al; licensee BioMed Central Ltd. This is an Open Access article distributed under the terms of the Creative Commons Attribution License (http://creativecommons.org/licenses/by/2.0), which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.
Abstract Tumor related pancreatic surgery has progressed significantly during recent years. Pancreatoduodenectomy (PD) with lymphadenectomy, including vascular resection, still presents the optimal surgical procedure for carcinomas in the head of pancreas. For patients with small or low-grade malignant neoplasms, as well as small pancreatic metastases located in the mid-portion of pancreas, central pancreatectomy (CP) is emerging as a safe and effective option with a low risk of developing de-novo exocrine and/or endocrine insufficiency. Total pancreatectomy (TP) is not as risky as it was years ago and can nowadays safely be performed, but its indication is limited to locally extended tumors that cannot be removed by PD or distal pancreatectomy (DP) with tumor free surgical margins. Consequently, TP has not been adopted as a routine procedure by most surgeons. On the other hand, an aggressive attitude is required in case of advanced distal pancreatic tumors, provided that safe and experienced surgery is available. Due to the development of modern instruments, laparoscopic operations became more and more successful, even in malignant pancreatic diseases. This review summarizes the recent literature on the abovementioned topics. :
Background Various pancreatic diseases demand surgery, among which malignant tumor resection is the mainstay of pancreatic surgery, including local, partial, or total pancreatectomy. Pancreatic tumor removal has during the recent years become a routine surgical procedure, and the resection rate of affected patients has markedly increased within the last decades. Consequently,
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