Pancreatic cancer indications for and radicality of surgery

Surgery of pancreatic cancer can nowadays be performed in a safe manner and with a continuous reduction of morbidity and mortality (<5%) in centers of excellence. The reduction of mortality by efficient management of complications and reduced incidence of complications by elaborate surgical techniques are contrasted by the inadequate oncologic results after surgery for pancreatic cancer. The safety of the procedures in skilled hands in recent years has led to a more aggressive surgical approach towards the disease. Resections of the portal vein and adjacent organs (multivisceral) are justified to achieve a RO situation. Resections of arterial structures and extended lymphadenectomy do not withstand evidence-based evaluation and cannot therefore be recommended. Radical surgical therapy under these circumstances is the prerequisite for efficient adjuvant therapy and subsequent curative treatment options for pancreatic cancer.