In the mid-1990s pancreatoduodenectomy can be performed at regional referral centers with an operative mortality of 1% to 2%. In addition, a number of centers around the world are now reporting 5-year survivals between 20% and 30% for patients with resected pancreatic cancer. In recent years a debate has continued as to the proper extent of resection for these patients, in part because numerous resective and reconstructive options are available. In broad terms, operations can be categorized as 'standard' or 'radical.' In general, standard operations tend to have lower postoperative morbidity and mortality. Multiple factors influence postoperative survival, including intraoperative blood loss, perioperative transfusions, type of operation, hospital mortality, tumor biology, and adjuvant therapy. Among these parameters, tumor biology is the most important by multivariate analysis. Recent data suggest that the quality of survival is better with standard operations and best with the pylorus-preserving pancreatoduodenectomy. Nevertheless, debate will continue about the proper extent of resection until a well-controlled randomized trial has addressed this issue.
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