Necessity and guidance of preoperative pathological diagnosis of spaceoccupying lesions of the head of pancreas

The need of pathological diagnosis of space occupying lesions of the head of pancreas before pancreaticoduodenectomy is a hot issue in the pancreatic surgery. According to the present guidelines and consensus, pathological diagnosis is not required if the patient with clinically resectable space occupying lesions of the head of pancreas. However, confirmation of tumor malignancy is mandatory for patients with borderline resectable disease to be treated by neoadjuvant therapy, for patients with unresectable tumors to be treated by chemoradiotherapy, and for patients with unresectable tumors to be treated with a palliative bypass procedure during the surgical exploration. When making a clinical decision, surgeons should fully communicate with the patients and their relatives, under the direction of a multidisciplinary team, and have a correct and dialectical knowledge of the guidelines and consensus. This would be helpful for the improvements of the diagnosis and treatment of space occupying lesions of the head of pancreas.