Standard resection of pancreatic cancer and the chance for cure

Pancreatic cancer is a devastating disease. Radical surgical resection offers the only chance for cure. In search of improved survival, more extended resections have been advocated. On the other hand, pylorus-preserving pancreaticoduodenectomy (PPPD) has emerged as an organ-preserving alternative to a standard Whipple resection (SW). However, its oncologic safety has been under debate. Furthermore, reports of increased rates of delayed gastric emptying have been made. We performed a Medline-PubMed search for relevant articles. In addition to nonrandomized reports, we found 3 randomized controlled trials (RCTs) comparing SW or PPPD with SW with extended lymphadenectomy and 4 RCTs comparing SW with PPPD. For resection of pancreatic cancer, SW and PPPD are probably equally effective. Extended resections are not warranted on the basis of the current evidence and should only be offered in an experimental setting.

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