Surgicalandmedicaltherapyforpancreatic carcinoma Conor J. Magee MB, ChB, FRCS ResearchFellow Paula Ghaneh MB, ChB, FRCS (Gen.) Clinical Lecturer in Surgery John P. Neoptolemos * MB, BChir, MD, FRCS Professor of Surgery Department of Surgery, University of Liverpool, 5th Floor UCD Building, Royal Liverpool University Hospital, Daulby Street, Liverpool, L69 3GA, UK Progress on the treatment of pancreatic ductal adenocarcinoma has involved advances in medical and surgical care with important contributions from disciplines such as radiology and intensivecare.Inthelastdecadelargerandomizedcontrolledtrialshavebeenundertakenthat demonstratetheimprovedpatientoutcomes.Thereisanincreasedriskofpancreaticcancerin chronic pancreatitis, hereditary pancreatitis and a variety of familial cancer syndromes. The optimum outcome from pancreatic cancer needs management by multidisciplinary teams in regional specialist units. Endoscopic stenting, good pain relief and pancreatic enzyme supplementation are the basis of care in advanced pancreatic cancer. Chemotherapy prolongs survival in advanced pancreatic cancer with little to be gained using drugs other than 5FU. Resection, if possible, prolongs life and provides the best quality of life. Adjuvant chemo- radiotherapyisofnobene®tbutchemotherapymayimprovesurvival.Alongsidetheevolution in clinical management has been the elucidation of the molecular events that underlie pancreatic cancer and this knowledge has guided the introduction of targeted treatments for pancreatic cancer. Keywords: pancreatic cancer; chemotherapy; radiotherapy; gene therapy; surgery; adjuvant therapy; randomized trials. Pancreatic ductal adenocarcinoma (PDAC) is the 4th to 5th leading cause of cancer- related death in the Western world and is characterized by an incidence:mortality ratio approaching unity. The latest ®gures from IARC estimate that in the year 2000 therewillhavebeen217000newcasesofpancreaticcancerand213000deaths. 1 The onlytreatmentmodalitythathasbeenconsistentlyshowntoexertapositivein¯uence on survival is surgery. However, resection rates are low, 2.6% in non-specialist units 2 , but greater in specialist units. 3±5 1521±6918/02/$ - see front matter * c 2002 Elsevier Science Ltd. All rights reserved. Best Practice & Research Clinical Gastroenterology Vol. 16, No. 3, pp. 435±455, 2002 doi:10.1053/bega.2002.0317, available online at http://www.idealibrary.com on 7 * To whom correspondence should be addressed