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Chirurgie 24. Oktober 2013

4th Austrian pancreas day: a summary of the surgical management of exocrine pancreatic neoplasms

Background: In the twenty-first century management of pancreatic diseases remains a challenge for surgeons, gastroenterologists, anesthesiologists, pathologists, radiologists, and oncologists. While the techniques of pancreatic resections have not changed within the last decades, nowadays multimodal neoadjuvant treatment strategies offer curative surgical therapy to a higher percentage of patients. Furthermore, new knowledge has emerged about the biology and treatment of cystic lesions of the pancreas.

Methods: We summarized the surgical topics of the upcoming meeting entitled “4th Austrian Pancreas Day”.

Results: Even after decades of intense research the ductal adenocarcinoma of the pancreas stays a deadly disease. A curative R0 resection remains the only treatment potentially prolonging overall survival. Esposito et al. as well as Verbeke et al. demonstrated that axial slicing and extensive tissue sampling, raises the R1 resection rate up to 85 %, compared to R1 rates of 10–20 % in older series with basic pathological workup. In locally and advanced and borderline resectable pancreatic cancer, novel chemotherapeutic regimes like Folfirinox in combination with or without radiotherapy proved to offer satisfying response rates, making curative resection feasible in more patients. At the same time, the number of patients incidentally diagnosed with cystic lesion of the pancreas is continuously rising. However, only some of these patients need pancreatic surgery while others can be safely observed. In 2012 the International Association of Pancreatology has revised their guidelines for the management of mucinous cystic neoplasms and intraductal papillary mucinous neoplasms, deemphasizing cyst size as a worrisome feature.

Conclusions: Today, patients with pancreatic neoplasms need to be managed by an experienced interdisciplinary team. In such professional setting it should by our goal to curatively resect as much as possible patients with pancreatic malignancies and at the same time reduce the number of unnecessary operations of benign cystic neoplasms.

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