Emerging concepts in the management of pancreatic ductal adenocarcinoma

Abstract

Pancreatic ductal adenocarcinoma is characterised by poor oncological outcomes with curative treatment only possible for a minority. Symptoms are dependent on the stage of the disease and location within the pancreas with constitutional decline often prominent. Patients require biochemical investigations and accurate imaging with CT to determine stage of disease and local resectability. CT-PET and endoscopic ultrasound are increasingly used preoperatively. Surgery remains the cornerstone of curative management and can be performed using minimally invasive approaches. Vascular resection and combination treatment with chemoradiotherapy are also utilised for suitable patients. Perioperative outcomes may be optimised using enhanced recovery pathways. Quality standards have been defined for individual clinicians and units to benchmark their clinical outcomes. The developments described hold promise in improving outcomes from pancreatic ductal adenocarcinoma. Keywords: Pancreatic ductal adenocarcinoma, Pancreatic resection, Laparoscopic surgery, Robotic surgery