What are the problems associated with the surgical treatment of patients with pancreatic cancer?

Modern surgical therapy of pancreatic cancer has resulted in few long‐term survivors. There are several reasons. First, most patients are not diagnosed in an early tumor stage, resulting in a minority of patients undergoing surgical resection. A breakthrough in screening methodology is required until this most major of obstacles can be overcome. Second, inaccurate clinical tumor staging is all that is available for the majority of patients, since most patients are not resected. Imaging techniques used for clinical staging require anatomic verification before clinical staging can be reliable. Then adequate comparison of treatments for patients who never receive anatomical staging can accomplished. Postoperative tumor staging using anatomical methods from intraoperative findings and examination of a surgical specimen require a staging system that is simple and directly correlates with survival. The best staging system can be developed only with international cooperation. An adequate comparison of the results of treatment will then be possible. Two broad treatment areas that are most promising are surgical (extending resections to yield negative surgical margins) and adjuvant protocols (beginning with a variety of radio sensitizing chemotherapeutic agents).