1611 Review www.expert-reviews.com ISSN 1473-7140 © 2008 Expert Reviews Ltd 10.1586/14737140.8.10.1611 Pancreatic adenocarcinoma (PC) is the most common malignant tumor of the pancreas and currently represents the fourth leading cause of cancer-related death in the USA. In 2008, an estimated 37,680 new patients will be diag- nosed with PC, approximately 75% of whom will have tumors in the pancreatic head and almost all of whom will ultimately succumb to their disease [1] . This high mortality rate is due, in large part, to the 85% of patients who are identified to have locally advanced or metastatic disease on initial staging and in whom attempts at surgical resection are contraindicated. Even for the 10% of patients who present with a good performance status and localized disease, how- ever, surgical resection alone – long character- ized as the only potentially curative treatment for patients with PC – is fraught with unacceptably high rates of postoperative recurrence and sub- sequent disease-related death [2–6] . Owing to its aggressive tumor biology and the technical dif- ficulties associated with achieving a microscopi- cally complete (R0) resection, PC is associated with 5-year postoperative survival rates that have failed to improve dramatically over time, despite concurrent improvements in diagnostics, stag- ing and perioperative care [7] . Indeed, historic rates of long-term disease-free survival have led many to adopt a nihilistic approach, even toward patients with resectable PC [8] . Although neces- sary for long-term patient survival, surgery alone is therefore clearly insufficient. Over the past two decades, an increasing emphasis has been placed upon the development and utilization of multimodality approaches to therapy for patients with resectable adenocarci- noma of the pancreatic head. Both adjuvant sys- temic chemotherapy and chemoradiation have been used in the pre- and postoperative setting in an attempt to reduce rates of locoregional and distant recurrence and thereby to prolong sur- vival. The understanding and appreciation of the utilization of these modalities have grown as dedicated multidisciplinary pancreatic tumor groups have developed at referral centers around the country. At their most basic level, these groups are composed of surgeons, gastroenter- ologists, medical oncologists, radiation oncolo- gists, radiologists and interventional radiologists, nutritionists, nurses and allied personnel who administer their respective therapies to patients with pancreatic cancer. At their best, these groups act in a coordinated fashion to provide comprehensive care to the patient with pancre- atic cancer from diagnosis through treatment, improve the quality of care through the analysis Maki Yamamoto, David K Imagawa and Matthew HG Katz † † Author for correspondence Assistant Professor of Surgery, Division of Hepatobiliary and Pancreas Surgery, Department of Surgery, The University of California at Irvine, 333 City Boulevard West, Suite 1205, Orange, CA 92868-3298, USA Tel.: +1 714 456 8899 Fax: +1 714 456 3487 katzmh@uci.edu Although surgery is considered the only treatment to offer patients with localized pancreatic adenocarcinoma a chance of cure, resection alone is rarely sufficient for long-term survival. High rates of postoperative recurrence and subsequent disease-related mortality have, over the past two decades, encouraged the study and use of multimodality strategies that include adjuvant systemic chemotherapy and radiation. These modalities have been utilized both preoperatively and postoperatively with encouraging results. Moreover, their use has led increasingly to the development of institutional multidisciplinary groups with a focused interest in the care of patients with pancreatic malignancy, which have become responsible for the diagnosis, staging, treatment, follow-up and study of these patients. We review the rationale for the use of and the outcomes that may be achieved through the use of a multidisciplinary approach to patients with resectable adenocarcinoma of the pancreatic head. Keywords : adjuvant therapy • borderline resectable • chemoradiation • chemotherapy • neoadjuvant therapy • pancreatic cancer • pancreaticoduodenectomy • resectable Multidisciplinary management of resectable adenocarcinoma of the pancreatic head Expert Rev. Anticancer Ther. 8(10), 1611–1621 (2008)