Malignant pancreatic tumors: Indication for operation

Background: The prognosis of malignant pancreatic tumors is fairly poor: mostly diagnosis is established in an advanced stage of disease with the patient already suffering from locoregional spread or liver metastases. The ductal adenocarcinoma is the most common malignant tumor of the exocrine pancreas. Between cancer of the Papilla Vateri - periampullary tumors - and the ductal adenocarcinomas differences are only marginal. Indication for surgery has similar implications for both tumors. Methods: Based on our own experience the diagnostical and therapeutical algorithms are re-evaluated in order to describe the indication for surgery for malignant pancreatic tumors. Results: The indication for curative surgery and palliative procedures are described. Conclusions: Laparoscspic exploration as a tool for surgical exploration has proven to be worthwhile. It has changed the algorithm for preoperative staging. Radical surgery for resectable tumors is the only chance for permanent cure. Procedures for irresectable tumors should be charged with a minimum of invasion, and the intervention should be individualized for each patient. It has been widely accepted, that indication for radical surgery or palliation procedures can be established using non- or minimal invasive staging proccdures including a staging laparoscopy.