Pancreatic cancer: Is the surgeon still relevant?

Despite advances in multimodal therapy, surgery remains central to the management of patients with resectable pancreatic adenocarcinoma. Complete surgical clearance of disease offers the only real, albeit slim, chance of cure. For the greater proportion of patients with resectable macroscopic but occult microscopic disease, who ultimately recur early, short-term outcomes are still better compared to other currently available treatment modalities. Morbidity rates following pancreatic resection are worse than cancer surgery data for other intraabdominal sites however, and involved margins are an unsurprising predictor of poor oncological outcome. Patient selection is therefore key. Refinements in surgical technique and treatment algorithms, such as the evolving use of neoadjuvant therapy, have improved appropriate selection for surgery, resectability rates and early postoperative outcomes. Review of contemporary Australian observational follow-up data highlights favourable local morbidity and mortality results, but persistently disappointing long-term survival outcomes reflective of the international picture. The surgeon's current role remains to achieve complete local resection with minimal morbidity. Such an achievement maximises the successful utilisation of multimodal therapies targeting microscopic disease, and preserves the remaining quality of life for those patients with ultimately incurable disease suffering from aggressive tumour biology.