Recent advances in the surgical treatment of pancreatic cancer

Pancreatic cancer remains the fourth commonest cause of cancer related death in the western world[1]. The prognosis remains dismal due partly to late presentation, with associated low resectability rates, and the aggressive biological nature of these tumors. The median survival time from diagnosis in unresectable tumors remains only 4-6 mo. For those patients amenable to surgical resection over the last 20 years have seen marked improvements in postoperative mortality and morbidity, especially in specialist pancreatic centres[2,3]. Despite these changes long-term survival remains low, with a total 5-year survival rate remaining less than 5%. Patients with ampullary cancer have a better 5-year survival of 40%-60%. Resection, however, remains the only chance of long term survival with adjuvant therapies providing disappointing results. Operability remains low due to the local and distant extent of the disease. Assessment of this extent has been greatly advanced by modern radiological techniques.