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2015 ; 27
(4
): 332-48
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Pancreatic cancer surgery: past, present, and future
#MMPMID26361403
Griffin JF
; Poruk KE
; Wolfgang CL
Chin J Cancer Res
2015[Aug]; 27
(4
): 332-48
PMID26361403
show ga
The history of pancreatic cancer surgery, though fraught with failure and
setbacks, is punctuated by periods of incremental progress dependent upon the
state of the art and the mettle of the surgeons daring enough to attempt it.
Surgical anesthesia and the aseptic techniques developed during the latter half
of the 19(th) century were instrumental in establishing a viable setting for
pancreatic surgery to develop. Together, they allowed for bolder interventions
and improved survival through the post-operative period. Surgical management
began with palliative procedures to address biliary obstruction in advanced
disease. By the turn of the century, surgical pioneers such as Alessandro
Codivilla and Walther Kausch were demonstrating the technical feasibility of
pancreatic head resections and applying principles learned from palliation to
perform complicated anatomical reconstructions. Allen O. Whipple, the namesake of
the pancreaticoduodenectomy (PD), was the first to take a systematic approach to
refining the procedure. Perhaps his greatest contribution was sparking a renewed
interest in the surgical management of periampullary cancers and engendering a
community of surgeons who advanced the field through their collective efforts.
Though the work of Whipple and his contemporaries legitimized PD as an accepted
surgical option, it was the establishment of high-volume centers of excellence
and a multidisciplinary approach in the later decades of the 20(th) century that
made it a viable surgical option. Today, pancreatic surgeons are experimenting
with minimally invasive surgical techniques, expanding indications for resection,
and investigating new methods for screening and early detection. In the future,
the effective management of pancreatic cancer will depend upon our ability to
reliably detect the earliest cancers and precursor lesions to allow for truly
curative resections.
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