Embryonal-based surgery for pancreatic head cancer

Introduction. More than half of patients with pancreatic head cancer (PHC) have locally advanced tumor and/or distant hematogenous metastases at the time of diagnosis. Thus, the prognosis for most patients diagnosed with PHC is poor, with a 5-year survival rate of 8% at all stages. The current decade has witnessed a rapid evolution in pancreatic head cancer surgery. In particular, this, alternative as compared to the classical approach to pancreatoduodenal resection (PDR) treatments begant appear, such as the Artery-first approach, Total Mesopancreas Excision (TMpE), No-touch approach. All of the above methods mainly aim to increase resectability and the frequency of R0 resection, and to improve long-term oncological outcom. Based on the analyzed literature, we came to the conclusion that an increase in the volume of surgical intervention in patients with pancreatic cancer does not improve oncological outcomes. Extended lymph node dissection has not shown any benefit in meta-analyses. There are no studies proving the effectiveness and feasibility of performing mesopancreasectomy.