Surgical management of pancreatic diseases is considered one of the greatest challenges in general surgery and requires specialized knowledge of the regional anatomy and experience in perioperative management of cases. In most instances, pancreatic pathology is associated with malignant or premalignant lesions, either solid or cystic in nature.
Pancreatic Adenocarcinoma: Pancreatic cancer is the fourth leading cause of death from malignant neoplasms in Western populations. Major predisposing factors include smoking, high fat and “junk food” consumption, obesity, a history of chronic pancreatitis, and the presence of certain genetic disorders. Depending on its location in the head, body, or tail of the pancreas, symptoms may vary and include painless obstructive jaundice, epigastric pain radiating to the back and sudden onset or poorly controlled diabetes, among others. Despite the generally poor prognosis for patients with pancreatic cancer, modern management of these patients appears to be beginning to yield positive results.
Cystic Pancreatic Lesions: With the improvement and increased use of imaging methods, such as CT and MRI, the detection of pancreatic cystic lesions has increased dramatically. Some of these are considered premalignant, such as mucinous cystic neoplasms (MCN), main-duct intraductal papillary mucinous neoplasms (MD-IPMN), and solid pseudopapillary neoplasms (SPN). Conversely, some cystic lesions are benign, such as serous cystic neoplasms, pseudocysts, or other cystic lesions with uncertain behavior, like branch-duct intraductal papillary mucinous neoplasms.
Other Conditions: The pancreas can also harbor metastases from other organs, such as the kidney or colon, as well as other primary lesions such as lymphoma and sarcoma. Less commonly nowadays, lesions related to chronic pancreatitis are seen, a condition primarily caused by alcohol abuse, as well as recurrences of acute pancreatitis.
Management: Surgery is the cornerstone of treatment for pancreatic diseases. Common procedures, depending on the nature and location of the lesion, include pancreaticoduodenectomy (Whipple procedure), distal pancreatectomy, total pancreatectomy, and enucleation.
Modern and personalized management of pancreatic diseases requires multidisciplinary collaboration, including preoperative assessment of disease resectability and potential neoadjuvant therapy, specialized intraoperative technique and knowledge of anatomy, variants, and complications, postoperative follow-up using specific recovery protocols, and consideration of adjuvant therapy. Consequently, optimal management of pancreatic diseases primarily requires collaboration among various medical specialties within the framework of an oncology board, including the specialized surgeon, radiologist, radiation oncologist, gastroenterologist, pathologist, and medical oncologist.
