Surgical aspects of pancreatic cancer treatment

In the structure of all oncological diseases in our country in 2023, pancreatic cancer accounts for about 3%. At the same time, over the past decade, the incidence of pancreatic cancer among men and women in the Russian Federation has increased by 15% on average, and mortality from this disease – by 20% [1]. Despite the greater availability of medical care and the introduction of screening, this pathology is often detected late: in 58% of cases in a metastatic form, and stages I–II are detected only in a quarter of cases. This is associated with the worst one-year overall survival rates among all malignant tumors – less than 30% [2]. Surgical treatment of malignant tumors of the pancreas is the only radical method of treating this pathology. This is a fairly «young» area of surgery, which received rapid development only in the second half of the 20th century. Historically, this is due to the deep retroperitoneal location of the organ, as well as the technical complexity of interventions and the high risk of postoperative complications and mortality. Indeed, for a long time after the publication 
of the first works in this area by V. Kausch and A. Whipple, who performed and described the main methods of surgical interventions for cancer of the head of the pancreas, the immediate surgical and oncological outcomes of this treatment remained disappointing. Only in the last few decades surgeons have made some progress in this area, which is explained by better managing of surgical complications (due to the improvement of surgical techniques, effective diagnostics in the postoperative period, the role of interventional radiologists, targeted antibacterial therapy, etc.), as well as improved oncological prognoses in connection with the perioperative chemotherapy [3].