Survival benefit of extended resection in pancreatic cancer

Extended resection for pancreatic cancer has been performed successfully in many centers around the world. The approaches currently used include extended lymph node dissection with extended soft-tissue clearance and resection of adherent vessels in patients with cancer in the pancreatic head. Recently, these approaches have been extended to include simultaneous resection of minimal metastatic disease and resection for locally recurrent disease. The results of several controlled clinical trials did not support the use of extended lymph node dissection; however, it is likely that these studies are underpowered to show a survival benefit. With regard to portal/superior mesenteric vein (PV/SMV) resection, no controlled study is available, but it appears that the procedural risk is identical to standard resection. Therefore, the concept of PV/SMV resection seems justified to establish negative resection margins. The value of pancreatic resection in the setting of minimal metastatic disease and re-resection for locally recurrent disease should be proved in clinical studies because data are unavailable to generally support this approach. In summary, extended pancreatic resections are often tailored to highly selected patients and according to the center’s experience. The latter issue is especially critical because there is no scientific evidence for a survival benefit, and, therefore, the procedural risk has to be equally as low as in standard resection.