Surgical management of pancreatic cancer: a narrative review

Purpose: Pancreatic cancer (PC) is among the most aggressive gastrointestinal malignancies, characterized by rapid progression and early metastatic spread, resulting in a poor prognosis for affected patients. This review provides an overview of the various surgical options for PC, highlights key perioperative considerations, and discusses recent advances in the field. Current Concepts: Pancreatectomy is classified according to tumor location as distal, pancreaticoduodenectomy, or total. Three surgical stages have been established for a preoperative assessment based on resectability: resectable, borderline resectable, and unresectable. Discussion and Conclusion: The use of minimally invasive surgery for PC is increasing. Although upfront surgery followed by adjuvant chemotherapy remains the standard treatment for resectable PC, accumulating evidence suggests that neoadjuvant chemotherapy improves overall survival in borderline resectable cases, even though it does not increase resection rates.