Pancreatic surgery: new developments

The probability of developing pancreatic cancer during our lifetime is around 1.6%.

Nevertheless, the five-year survival as well as the possibility of cure from this neoplasm has increased in the last decade, reaching 35% (practically 1 in 3) for the initial stages of the disease. A large percentage of this success is due to developments in the field of Pathological Oncology with the use of new chemotherapeutic drugs, pre-operatively as well as post-operatively. However, what has changed dramatically in the treatment of pancreatic cancer is the surgical approach to these neoplasms.

The operative approach to pancreatic cancer

Better staging of pancreatic neoplasms
Initially, surgeons are able to better stage pancreatic neoplasms with the use of special CT or MRI scans that accurately demonstrate the relationship of the tumor to large vessels in the area (superior mesenteric vein or artery and tricuspid). This possibility, in advanced situations (locally advanced neoplasms), allows the use of pre-operative chemotherapy or radiotherapy with the aim of shrinking the tumor and its successful surgical removal.

Rapid recovery protocols
Also, with the use of enhancer recovery protocols (Enhancer Recovery After Surgery Protocol), such as those used in the Department of Liver & Biliary Surgery of HYGEIA, based on specific anesthetic, operative and postoperative strategies, pancreatectomies have become routine surgeries with rapid recovery of patient and short hospital stay.

Replacement of vessels with venous or synthetic grafts
In addition, tumors that invade large vessels such as the portal vein or the superior mesenteric vein can be safely removed, by replacing these vessels with venous or synthetic grafts (as in heart operations for coronary disease) and are now considered routine operations in specialized Departments Liver and Pancreatic Surgery as of HYGEIA. The same applies under certain conditions to tumors that infiltrate the triceps, that is, the artery that supplies the spleen, stomach and liver.

Robotic removal of pancreatic tumors
Another important development in the treatment of pancreatic cancer is the application of the robotic platform (robotic surgery) in the removal of pancreatic tumors. The use of the robot for selected tumors of the body as well as the head of the pancreas is an innovation applied in recent years that allows the same oncological surgeries to be performed with smaller incisions, less perioperative stress, less pain and faster patient recovery, also allowing where this also needs the faster start of chemotherapy.

The Department of Liver, Pancreatic and Biliary Surgery of HYGEIA has performed a large series of such operations in collaboration with distinguished centers in the USA. Of course, even for inoperable tumors of the pancreas, there is the possibility of destroying them with the intraoperative use of special electrodes that channel high-frequency electric current into the tumor, causing them to be destroyed. This technology, also known as Irreversible Electroporation or Nanoknife, seems to be particularly effective in selected patients with pancreatic cancer and has been applied to several patients at HYGEIA.

Multidisciplinary treatment of cancer patients
Finally, probably the most important development in the surgical treatment of pancreatic cancer is the multidisciplinary approach to these neoplasms, where with the guidance of Liver and Pancreatic Surgeons, Oncologists and Radiotherapists, the best “timing” of the therapeutic manipulations and surgical intervention.

Written by:
George Tzimas, Surgeon
Director of the Department of Liver & Biliary Surgery HYGEIA

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