Staging strategies for pancreatic adenocarcinoma: What the surgeon really wants to know

Pancreatic cancer remains a highly lethal disease in spite of new developments in early diagnosis, marked improvements in surgical morbidity and mortality, and introduction of promising adjuvant and neoadjuvant therapies. This ongoing poor prognosis can be explained in part by the relatively advanced stage of these malignancies at the time of presentation and diagnosis. The staging process in this disease lacks standardization and differs considerably from center to center. Acknowledging that it is impossible to achieve a perfect workup to rule out micrometastatic disease, controversy persists regarding the optimal initial approach and subsequent staging of these tumors. A better, or at least a more standardized staging system, should help to improve disappointing results in the surgical treatment of pancreatic cancer, although such an improvement will be based more on the selection of patients than the actual therapeutic intervention. This paper addresses the current controversy in staging methodology for pancreatic and periampullary malignancies and offers an approach to the staging of pancreatic cancer.