Advancements in the surgical management of pancreatic masses: A comprehensive review

Pancreatic masses encompass a heterogeneous group of neoplasms, ranging from benign lesions like serous cystadenomas to malignant entities such as pancreatic ductal adenocarcinoma (PDAC). Timely and accurate differentiation between these masses is critical for tailoring optimal therapeutic strategies. This narrative review highlights the evolving landscape of surgical management for pancreatic masses, emphasizing the advancements in diagnostic modalities, surgical techniques, and perioperative care. Imaging modalities, including contrast-enhanced computed tomography (CT), magnetic resonance imaging (MRI), and endoscopic ultrasound (EUS), have enhanced the precision of diagnosis and staging. Histopathological evaluation remains indispensable for definitive diagnosis. Surgical interventions, including partial and total pancreatectomy, are explored based on tumor type and staging, with resection offering the only curative option for PDAC. Minimally invasive approaches, such as laparoscopic and robotic-assisted surgeries, have demonstrated reduced morbidity, quicker recovery, and comparable oncological outcomes to open procedures. The role of neoadjuvant therapy is discussed for resectable and borderline resectable tumors, with evidence suggesting improved surgical outcomes and overall survival. The review also addresses postoperative challenges, including pancreatic fistulas, delayed gastric emptying, and the management of endocrine and exocrine insufficiencies. Palliative strategies, such as biliary bypass and endoscopic stenting, are detailed for non-resectable tumors, prioritizing symptom relief and quality of life. Emerging technologies like intraoperative imaging, artificial intelligence, and precision medicine are reshaping the surgical approach, enabling personalized treatment plans. This comprehensive overview underscores the importance of a multidisciplinary approach in optimizing outcomes for patients with pancreatic neoplasms.