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Invited Critique
December 1, 2003

Changes in Morbidity After Pancreatic Resection—Invited Critique

Arch Surg. 2003;138(12):1315. doi:10.1001/archsurg.138.12.1315

The past 2 decades have seen tremendous improvements and refinements in pancreatic resections. The article in this issue of the ARCHIVES by Büchler and colleagues is a remarkable documentation of 617 pancreatectomies performed by a single group and echoes the results currently seen in many major centers. The pancreatoduodenectomy is now performed in a few hours at most major hospitals, with operative mortalities less than 4% and with most patients returning to normal function. Because pancreatectomy represents the only curative therapy for pancreatic adenocarcinoma, improvement in perioperative outcome is a first step toward effective treatment of this disease. However, the long-term outcome for pancreatic adenocarcinoma is still extremely poor. The actuarial 5-year survival in most major series is less than 20%, and even at major centers, there are few actual 5-year, disease-free survivors.1-3 Thus, the surgical procedure has prolonged survival but has had little effect on long-term outcome for most of the 30 000 patients each year treated for adenocarcinoma of the pancreas.

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