Carcinoma of the Pancreas: Current Status of Multimodal Therapy

Only multimodal treatment concepts may potentially improve the persisting poor prognosis of the carcinoma of the pancreas. In specialized centres surgery has reached a high level of security with a very low level of mortality. Infiltrations of the mesenterico-portal axis are not a contraindication to a curative oncological surgery. R0 and R1 resections should be followed by adjuvant chemotherapy with gemcitabine. Currently there is no evidence of benefit for a neoadjuvant radiochemotherapy in primary resectable carcinomas of the pancreas. The survival rates of primary resectable carcinoma patients with neoadjuvant pre-treatment correspond to those of primary resectable carcinoma patients with adjuvant therapy. Due to the high perioperative morbidity, some patients do not gain access to the adjuvant therapy within a reasonable time frame. Therefore, the significance of neoadjuvant therapy for resectable tumours should be re-evaluated in prospective randomised trials. In about one third of the patients with primary irresectable carcinomas of the pancreas, a radical resection can be performed after neoadjuvant radio-chemotherapy. For this patient group randomised prospective trials are urgently needed. In this context, however, only an experienced pancreatic surgeon can decide about the resectability or irresectability of a pancreatic tumour.