INTRODUCTIONPancreatic ductal adenocarcinoma is a highly lethal disease. It is estimated that in 2017 there will be 53 670 new cases and 43 090 deaths in the United States, which now ranks third among cancer related deaths. At the time of diagnosis, roughly 38% of patients have disease which appears to be localized to the pancreas without obvious metastases. Of those patients deemed operable on clinical grounds, 20‐57% are found to have inoperable disease on exploration depending on the extent and nature of preoperative staging. Most patients present with unsuspected metastatic disease, borderline resectable tumors, or locally advanced, unresectable disease owing to involvement of critical vascular structures: superior mesenteric artery (SMA), celiac trunk, common hepatic artery, or superior mesenteric vein (SMV)/portal vein. Despite recent advances in systemic therapy, even those fortunate few who are able to undergo immediate surgery remain largely incurable, with a 5‐year survival of 25‐30% at best.It is clear from these data that two parallel initiatives are essential if we are to improve patient survival. The first is any strategy that will result in an increase in successful R0 resection of the primary tumor and regional nodes (microscopically margin‐negative resection, in which no gross or microscopic tumor remains
Journal of Surgical Oncology – Wiley
Published: Jan 1, 2018
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