Surgery for pancreatic cancer: current controversies and challenges.

Lay abstract Two main areas of focus in pancreatic cancer research are the high rates of post-surgery complications and poor survival despite completely removing the tumor. Complete, margin-negative resection (where some healthy tissue is removed to ensure the whole tumor is cut out) is the only way to ensure long-term survival. However, such extensive resections, especially when they involve nearby blood vessels and/or organs, should only be undertaken if the imaging done pre-surgery indicates the possibility that a complete, margin-negative resection can be achieved. It should be noted that the removal of lymph nodes, in addition to the ones normally removed during a pancreatic resection, does not confer a survival benefit. Distal pancreatectomy (performed for tumors involving the body or tail of the pancreas) is safe and feasible using minimal access methods; however, the safety of minimally-invasive pancreatoduodenectomy (performed for tumors of the head of the pancreas) remains to be proven. The oncological benefit of minimally-invasive distal pancreatectomy over open surgery has not been established.