Invited Lecture(JSGS)
Sat. November 4th   11:30 - 12:00   Room 8: Portopia Hotel Main Building Kairaku 1+2
Invited Lecture16
State of the art surgery for pancreatic cancer
Thilo Hackert
Department of General, Visceral and Thoracic Surgery, University Medical Center Hamburg-Eppendorf
Background: Surgical resection is the backbone of therapy for pancreatic cancer (PDAC) and can - embedded in a multimodal treatment approach - achieve long-term survival in this fatal disease. The develop-ment of surgical techniques as well as specialization and specifically complication management in pancreatic surgery have improved surgical outcomes as well as oncological results in PDAC surgery in recent decades. His-torical morbidity and especially mortality rates of up to 80 % have decreased to below 5% today.

Current situation: Standard resections including partial or total pancreateo-duodenectomy (PD) as well as distal pancreatectomy (DP) are well-standardized today and, especially for DP, minimally-invasive and robotic procedures are regarded as appropriate approaches, also for PDAC surgery. For PD, this is still a contro-versial issue as only few high-quality studies have been published to date. For advanced surgery in borderline (BR) and locally advanced (LA) PDAC, open surgery remains the gold standard. In BR-PDAC, venous resection has become a widely accepted procedure and can be performed safely with good oncological outcomes. Also, patients with LA-PDAC are increasingly considered for surgery after induction therapy. Besides venous resection, these patients often require special techniques to handle potential arterial involvement. Two possibilities have been established, namely a radical artery-sparing technique ("divestment" / "TRIANGLE" operations) or en-bloc resection of the artery with an arterial reconstruction. Both techniques are potentially burdened by a learning curve and need a high level of surgical experience. Prognostically, R0 resections can be achieved by either tech-nique and in this situation, median survival times up to 4 years have been reported. The remaining challenge today is the correct selection of patients who will benefit oncologically from these extended approach-es.

Future Perspective. Besides the further evaluation of minimally-invasive and robotic approaches, induction therapy followed by surgery is currently investigated not only in LA-PDAC but also for oligo-metastatic PDAC, especially for liver and ling metastases but also extending to minimal peritoneal seeding which could extend surgical indications in the future. The use of induction therapy will be evaluated in terms of the best regimen and duration in ongoing studies, furthermore, better markers to evaluate therapy response and finally decide for extended surgery are under investigation which will allow to stratify patients better and thereby improve results and prognosis further.
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