Reviewing the standard of care in pancreatic adenocarcinoma: A critical appraisal

Abstract

Treatment of pancreatic adenocarcinoma is still a great challenge to the surgeon. Although recent investigation and treatment protocols have redefined the limits of resectability and adjuvant care, survival outcome still remains dismally low. Because surgical resection of localized disease remains the only hope for curing pancreatic adenocarcinoma, all advances in diagnostic imaging and perioperative care have been aimed at improving the surgical outcome. In the present article, we discuss new developments and the existing controversies in the diagnosis, staging, determination of resectability, and the progress in surgical technique, palliation and, importantly, adjuvant and neoadjuvant therapy, and highlight the latest standard of care wherever possible. Where consensus is lacking, available literature is discussed to narrow the debate and provide a working formula for the readers at large. It is finally understood that for the best outcome, treatment should be tailored to the patient. Although surgical outcome improves in expert hands, the overall survival remains poor irrespective of centres.