Important points for the standard treatment of resectable pancreatic cancer

The Prep-02/JSAP-05 study showed that preoperative gemcitabine with S-1 (GS) significantly prolongs overall survival. Based on this result, the standard treatment sequence for resectable pancreatic ductal adenocarcinoma is preoperative chemotherapy, appropriate radical resection, and postoperative adjuvant chemotherapy. Patients with positive peritoneal washing cytology had a significantly poorer overall survival after surgery. Peritoneal washing cytology may play an important role in determining resectability. Staging laparoscopy is used to detect peritoneal dissemination and small liver metastases as well as to obtain peritoneal washings for cytologic analysis. While staging laparoscopy contributes to determining resectability, the indications are controversial because of possible complications. Extended lymph node and nerve plexus dissection should not be performed because they do not improve the postoperative prognosis and may make continued administration of adjuvant chemotherapy difficult. Patients' prognosis may be improved by carrying out a series of procedures from diagnosis to treatment without delay.