New advances in the treatment of pancreatic carcinoma

Pancreatic carcinoma is still a challenging disease. Although there is no  randomized controlled trial (RCT) results, neoadjuvant  therapy is encouraged to perform on patients with “borderline resectable” or “resectable” pancreatic cancers, which could probably increase the R₀ resection rates.  There has been some modifications about resection approach in recent years, for example,  artery first, hanging maneuver, uncinate process first, etc, which seem as safe and effective options. Because of the modification of pathologic classification of R₀ and R₁ resection for pancreatic cancer, the clinical outcomes of R₁ resection need to be reevaluated. The extent of lymphadenectomyin pancreaticoduodenectomy remains controversial. Based on several RCT reports, dissection of 2nd group of lymph nodes is recommended  according to the Japan Pancreas Society classification. The discussion and clinical application about the concept of mesopancreas will help to improve the status of retroperitoneal margins via standardized surgical procedures.