The role and techniques of vascular resection

Surgical resection for pancreatic adenocarcinoma remains the only single modality with the potential for cure or long-term survival. With improvements in surgical techniques and perioperative management, the morbidity and mortality associated with pancreatic resection has significantly improved. Nonetheless, the long-term oncologic outcomes of patients with pancreatic cancer have remained relatively poor despite these advances due to the biological aggressiveness of the disease and its widely disseminated nature at the time of diagnosis. Identification of patient- and tumor-specific risk factors and use of novel resectability classifications have now facilitated prediction of patients who may derive benefit from surgical procedures. Furthermore, significant improvements in the activity of systemic and locoregional therapies has resulted in an increase in the number of patients that may benefit from selectively aggressive operations with the need for more complex vascular procedures to accomplish oncologically effective resections. Any surgeons involved in the operative care of patients with pancreatic cancer should therefore have significant training and experience in these advanced techniques and have a full comprehensive understanding of expected risks and outcomes of such interventions.