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The Progress of Pancreatectomy for Pancreatic Cancer Treatment
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The Progress of Pancreatectomy for Pancreatic Cancer Treatment

A special issue of Cancers (ISSN 2072-6694). This special issue belongs to the section "Clinical Research of Cancer".

Deadline for manuscript submissions: 30 June 2026 | Viewed by 14220

Special Issue Editors

Prof. Dr. Reinhold Függer

E-Mail Website
Guest Editor
Department of General, Visceral, Thoracic and Transplant Surgery, Ordensklinikum Linz, 4010 Linz, Austria
Interests: surgical oncology; pancreas, liver; bile; upper GI; surgical infection
Special Issues, Collections and Topics in MDPI journals
Prof. Dr. Matthias Biebl

E-Mail Website
Co-Guest Editor
Department of Surgery, Ordensklinikum Linz, 4020 Linz, Austria
Interests: surgical oncology; upper GI cancer; esophageal cancer; gastric cancer; clinical trials; minimally invasive surgery; robotic surgery
Special Issues, Collections and Topics in MDPI journals

Special Issue Information

Dear Colleagues,

Pancreatic cancer represents one of the most challenging areas in gastrointestinal oncology. Surgery plays a key role in pancreatic cancer therapy because surgical resection is a precondition for curative treatment. Major advances have been achieved in pancreatic surgery, with a significant improvement of perioperative outcome parameters due to centralisation in specialised centres. Recurrence-free survival and overall survival have been found to increase following multimodal therapy, with surgery being of decisive influence. However, research defining the role of surgery in multimodal treatment regimens, with special attention paid to resectability and extended resections, as well as the potential significance of minimally invasive resection—whether laparoscopic or robotic—is crucial for pancreatic cancer surgery in the future.

This Special Issue welcomes research in the topics: (a) surgery in the setting of multimodal therapy; (b) timing of surgery according to the status of resectability; (c) minimally invasive resection; (d) outcome research for resectable pancreatic cancer; (e) technique and results of extended pancreatectomy; (f) therapy of postoperative pancreatic fistulas Grad B or C; and (g) pancreatic cancer resection in portal hypertension.

Prof. Dr. Reinhold Függer
Prof. Dr. Matthias Biebl
Guest Editors

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Submitted manuscripts should not have been published previously, nor be under consideration for publication elsewhere (except conference proceedings papers). All manuscripts are thoroughly refereed through a single-blind peer-review process. A guide for authors and other relevant information for submission of manuscripts is available on the Instructions for Authors page. Cancers is an international peer-reviewed open access semimonthly journal published by MDPI.

Please visit the Instructions for Authors page before submitting a manuscript. The Article Processing Charge (APC) for publication in this open access journal is 2900 CHF (Swiss Francs). Submitted papers should be well formatted and use good English. Authors may use MDPI's English editing service prior to publication or during author revisions.

Keywords

  • pancreatic ductal adenocarcinoma (PDAC)
  • pancreatectomy timing in multimodal regimen
  • minimally invasive pancreatectomy for PDAC
  • pancreatectomy and resectability
  • extended pancreatectomy
  • vascular resection and reconstruction
  • outcome research—pancreatectomy for cancer in unselected patient cohorts
  • interaction of postoperative complications and preoperative or adjuvant therapy
  • postoperative pancreatic fistula

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Published Papers (7 papers)

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Research

Jump to: Review

14 pages, 519 KB  
Article
Minimally Invasive Versus Open Radical Antegrade Modular Pancreaticosplenectomy (RAMPS): A Multicenter Cohort Study on Surgical Radicality and Postoperative Outcomes
by Lukas Heinrich Poelsler, Ruben Bellotti, Florian Primavesi, Eva Maier, Ines Fischer, Helwig Wundsam, Patrick Kirchweger, Stefan Schneeberger, Stefan Stättner, Matthias Biebl and Manuel Maglione
Cancers 2026, 18(4), 633; https://doi.org/10.3390/cancers18040633 - 15 Feb 2026
Viewed by 442
Abstract
Introduction: Radical Antegrade Modular Pancreatosplenectomy (RAMPS) was developed to improve surgical radicality for left-sided pancreatic ductal adenocarcinoma (PDAC). Although widely accepted, the optimal surgical approach—open versus minimally invasive (MI)—is still being debated. Methods: We conducted a multicenter retrospective cohort study across [...] Read more.
Introduction: Radical Antegrade Modular Pancreatosplenectomy (RAMPS) was developed to improve surgical radicality for left-sided pancreatic ductal adenocarcinoma (PDAC). Although widely accepted, the optimal surgical approach—open versus minimally invasive (MI)—is still being debated. Methods: We conducted a multicenter retrospective cohort study across three Austrian centers, including all patients undergoing RAMPS between 2016 and 2023 indicated for suspected (pre-)malignant pancreatic lesions. Patients were grouped based on the surgical approach (MI vs. open). The primary endpoints were resection margin status and lymph node yield following PDAC resection. Secondary outcomes included survival for PDAC patients and postoperative complications; non-PDAC resections were also taken into account. Results: A total of 57 patients were included, of whom 34 had PDAC. In PDAC patients, the rate of tumor-free margins and the median lymph node yield were equivalent between the MI and open approaches (R0 rate: MI 92.9% vs. open 85%, p = 0.484; median lymph node yield: MI 16 (IQR 10–23) vs. open 19 (IQR 15–25), p = 0.314). Two-year overall survival was also comparable (MI: 71.6% vs. open: 66.4%, p = 0.479). Postoperative outcomes at 90 days, like CR-POPF and major complications (Clavien–Dindo ≥ IIIa), did not differ between the two approaches. MI-RAMPS showed non-significant favorable trends in median length of stay (p = 0.093) and likelihood of receiving adjuvant chemotherapy (p = 0.075). Conclusions: In our experience, MI-RAMPS demonstrates oncologic equivalence and similar early postoperative outcomes to open RAMPS, with potential advantages such as shorter length of stay and likelihood of receiving adjuvant chemotherapy. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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19 pages, 2720 KB  
Article
Evaluation of Nanoparticle-Based Plasma Enrichment on Individuals with Primary and Metastatic Pancreatic Cancer
by Ching-Seng Ang, Nicholas A. Williamson, Chelsea Dumesny, Michael G. Leeming, Keshava Datta, Swati Varshney, Mehrdad Nikfarjam and Hong He
Cancers 2025, 17(23), 3765; https://doi.org/10.3390/cancers17233765 - 25 Nov 2025
Cited by 1 | Viewed by 1148
Abstract
Background and Methods: Using a nanoparticle-based enrichment (Proteonano) methodology on human plasma samples, we achieved a substantial increase in identified proteins from ~700 to >5000 proteins compared to neat plasma digest. In a small-scale pilot test, we applied this methodology to a [...] Read more.
Background and Methods: Using a nanoparticle-based enrichment (Proteonano) methodology on human plasma samples, we achieved a substantial increase in identified proteins from ~700 to >5000 proteins compared to neat plasma digest. In a small-scale pilot test, we applied this methodology to a small cohort of plasma samples from pancreatic cancer (PC) patients with different disease stages: (I) primary tumor and (II) metastases, and compared them with healthy controls. Most identified proteins are within the Human Plasma Proteome Project (HPPP) database, and more than 300 proteins are on the list of FDA-approved drug targets. Results: We observed a large and significant increase in ribosomal proteins in the plasma of patients with metastatic PC. ADH1C and ADH1B, both members of the alcohol dehydrogenase family, were particularly upregulated in patients with liver metastasis. Fifteen other predicted secreted and/or cell surface–associated proteins with known cancer associations are also significantly altered and would otherwise go undetected in neat, digested plasma. Conclusions: The significant increase in proteome depth allows a strong foundation for future large-scale experimental and comparative analysis. Lastly, similar conclusions could be reached from comparing different mass spectrometers (Orbitrap Astral and Orbitrap Ascend) and columns (depth and throughput) setups on the same dataset, although the depth approach on the newer Orbitrap Astral instrumentations can reveal additional insights in the plasma proteome. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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18 pages, 3080 KB  
Article
Pancreatectomy with Celiac Axis Resection and Reconstruction for Locally Advanced Pancreatic Cancer
by Satoshi Mizutani, Nobuhiko Taniai, Makoto Sukegawa, Takahiro Haruna, Hiroyasu Furuki, Hideyuki Takata, Junji Ueda, Masato Yoshioka, Takayuki Aimoto, Shunichiro Sakamoto, Kenji Suzuki, Yoshiharu Nakamura and Hiroshi Yoshida
Cancers 2024, 16(23), 4115; https://doi.org/10.3390/cancers16234115 - 8 Dec 2024
Viewed by 2977
Abstract
Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary [...] Read more.
Background: With the advent of effective chemotherapy, conversion surgery (CS) has been performed in patients who have responded to pretreatment, even for pancreatic cancer diagnosed as unresectable (UR) at the time of initial diagnosis. In CS, major arterial resection and reconstruction are necessary for complete radical resection. Methods: We discuss the key points for safely performing pancreatectomy with celiac axis (CA) resection combined with reconstruction, divided into resection and arterial reconstruction. The possibility of safe pancreatectomy concurrent with CA resection and reconstruction depends on the ability to create a “golden view” that provides an unimpaired view of the Abdominal Aorta, CA, Superior Mesenteric Artery, Inferior Vena Cava, and left renal vein from the ventral side. Pancreatectomy concurrent with CA resection requires arterial reconstruction. Postoperatively, arterial blood flow must be maintained. To achieve this, tension-free and short bypass should be observed. Results: From 2014 to 2024, sixteen URLA patients underwent CS, requiring major artery en bloc resection after pretreatment. We performed DP-CAR in eight patients, gastrectomy-distal pancreatectomy-splenectomy (Appleby procedure) procedure in one patient, PD-CHAR in two patients, PD-CAR in two patients, TP-CAR(spleen preserving) in one patient, and TP-CAR+TG in two patients. In total, five patients required surgery with CA reconstruction. Histopathologically, four of the five patients had T4 pancreatic cancer. The R0 surgical rate was 80%. Complication of Clavien–Dindo IIIa or higher was observed in one patient. There were no deaths. Conclusions: Parallel to the determination of pretreatment, surgeons must be prepared to safely and reliably perform pancreatectomies that require concurrent major arterial resection and reconstruction. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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14 pages, 550 KB  
Article
Comparison of Survival Outcomes between Radical Antegrade Modular Pancreatosplenectomy and Conventional Distal Pancreatosplenectomy for Pancreatic Body and Tail Cancer: Korean Multicenter Propensity Score Match Analysis
by Jaewoo Kwon, Huisong Lee, Hongbeom Kim, Sung Hyun Kim, Jae Do Yang, Woohyung Lee, Jun Suh Lee, Sang Hyun Shin and Hee Joon Kim
Cancers 2024, 16(8), 1546; https://doi.org/10.3390/cancers16081546 - 18 Apr 2024
Cited by 5 | Viewed by 2277
Abstract
(1) Background: The aim of this study was to compare the survival benefit of radical antegrade modular pancreatosplenectomy (RAMPS) with conventional distal pancreatosplenectomy (cDPS) in left-sided pancreatic cancer. (2) Methods: A retrospective propensity score matching (PSM) analysis was conducted on 333 patients who [...] Read more.
(1) Background: The aim of this study was to compare the survival benefit of radical antegrade modular pancreatosplenectomy (RAMPS) with conventional distal pancreatosplenectomy (cDPS) in left-sided pancreatic cancer. (2) Methods: A retrospective propensity score matching (PSM) analysis was conducted on 333 patients who underwent RAMPS or cDPS for left-sided pancreatic cancer at four tertiary cancer centers. The study assessed prognostic factors and compared survival and operative outcomes. (3) Results: After PSM, 99 patients were matched in each group. RAMPS resulted in a higher retrieved lymph node count than cDPS (15.0 vs. 10.0, p < 0.001). No significant differences were observed between the two groups in terms of R0 resection rate, blood loss, hospital stay, or morbidity. The 5-year overall survival rate was similar in both groups (cDPS vs. RAMPS, 44.4% vs. 45.2%, p = 0.853), and disease-free survival was also comparable. Multivariate analysis revealed that ASA score, preoperative CA19-9, histologic differentiation, R1 resection, adjuvant treatment, and lymphovascular invasion were significant prognostic factors for overall survival. Preoperative CA19-9, histologic differentiation, T-stage, adjuvant treatment, and lymphovascular invasion were independent significant prognostic factors for disease-free survival. (4) Conclusions: Although RAMPS resulted in a higher retrieved lymph node count, survival outcomes were not different between the two groups. RAMPS was a surgical option to achieve R0 resection rather than a standard procedure. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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Review

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20 pages, 1181 KB  
Review
Surgical Perspectives on Neoadjuvant Therapy in Borderline Resectable and Locally Advanced Pancreatic Cancer
by Jingcheng Zhang, Menghang Geng, Helmut Friess, Ihsan Ekin Demir and Florian Scheufele
Cancers 2026, 18(7), 1131; https://doi.org/10.3390/cancers18071131 - 1 Apr 2026
Viewed by 309
Abstract
Background/Objectives: Neoadjuvant therapy (NAT) is now central to the management of borderline resectable (BRPC) and locally advanced (LAPC) pancreatic ductal adenocarcinoma (PDAC). This narrative review summarizes contemporary evidence and guidelines from a surgical perspective, with emphasis on pretreatment classification, post-NAT selection for [...] Read more.
Background/Objectives: Neoadjuvant therapy (NAT) is now central to the management of borderline resectable (BRPC) and locally advanced (LAPC) pancreatic ductal adenocarcinoma (PDAC). This narrative review summarizes contemporary evidence and guidelines from a surgical perspective, with emphasis on pretreatment classification, post-NAT selection for exploration, intraoperative vascular strategy, and postoperative management. Methods: We conducted a structured narrative review of randomized and prospective studies, high-quality observational cohorts, and major international guidelines published through 31 July 2025. Results: BRPC and LAPC remain primarily defined by vascular anatomy, but biologic and conditional factors are increasingly integrated into decision-making. NAT is the preferred initial strategy for BRPC and the standard induction approach for LAPC, with resection considered only in carefully selected responders. After NAT, contrast-enhanced CT combined with CA19-9 kinetics remains the core restaging platform, while FDG-PET, diffusion-weighted MRI, radiomics, and circulating biomarkers may serve as adjuncts in equivocal cases. Surgical exploration should be guided by physiologic recovery, the absence of metastatic progression, and multidisciplinary reassessment. Staging laparoscopy remains useful for detecting occult metastatic disease. Intraoperatively, vascular resection should be margin-driven rather than routine, with portal–mesenteric venous resection established in expert centers, whereas arterial resection remains highly selective. Periarterial divestment represents an artery-sparing alternative in selected cases. NAT does not appear to worsen short-term postoperative outcomes, but anticoagulation after venous reconstruction remains non-standardized. Conclusions: NAT has transformed BRPC/LAPC PDAC into a biology-gated, time-sequenced surgical pathway. Standardized reassessment, careful candidate selection, and the centralization of complex vascular procedures are essential to optimize outcomes. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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17 pages, 1371 KB  
Review
Surgical Strategies for Tumors of the Pancreas and Duodenum
by Rosyli F. Reveron-Thornton, Kelly X. Huang, Daniel Delitto, Michael T. Longaker and Jeffrey A. Norton
Cancers 2025, 17(18), 3091; https://doi.org/10.3390/cancers17183091 - 22 Sep 2025
Cited by 1 | Viewed by 2058
Abstract
The recommended surgery for pancreatic tumors is dependent on the diagnosis. For pancreatic adenocarcinoma, duodenal, and ampullary adenocarcinoma, a Whipple pancreaticoduodenectomy with lymph node dissection is recommended. For small < 2 cm or non-imageable gastrinomas, duodenal transillumination, duodenotomy, duodenal tumor excision and adjacent [...] Read more.
The recommended surgery for pancreatic tumors is dependent on the diagnosis. For pancreatic adenocarcinoma, duodenal, and ampullary adenocarcinoma, a Whipple pancreaticoduodenectomy with lymph node dissection is recommended. For small < 2 cm or non-imageable gastrinomas, duodenal transillumination, duodenotomy, duodenal tumor excision and adjacent lymphadenectomy is recommended. For large > 3 cm gastrinomas, a Whipple pancreaticoduodenectomy with adjacent lymph node dissection is recommended. For small 1–2 cm insulinomas, intraoperative ultrasound with enucleation is recommended. If the patient with gastrinoma, insulinoma, or multiple nonfunctional NETs occurs in the setting of MEN-1, a subtotal pancreatectomy with or without splenectomy with enucleation of pancreatic head tumors is recommended, with adjacent lymph node dissection. The detail of each procedure is described with illustrations. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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22 pages, 328 KB  
Review
A Review of Post-Operative Pancreatic Fistula Following Distal Pancreatectomy: Risk Factors, Consequences, and Mitigation Strategies
by Jurgis Alvikas, Shakti Dahiya and Genia Dubrovsky
Cancers 2025, 17(17), 2741; https://doi.org/10.3390/cancers17172741 - 23 Aug 2025
Cited by 3 | Viewed by 3872
Abstract
Post-operative pancreatic fistula (POPF) is a serious yet far too common complication following distal pancreatectomy (DP), as it affects 20–30% of patients after DP. POPF raises the risk of other complications and causes delays to a patient’s oncologic care. In this review, we [...] Read more.
Post-operative pancreatic fistula (POPF) is a serious yet far too common complication following distal pancreatectomy (DP), as it affects 20–30% of patients after DP. POPF raises the risk of other complications and causes delays to a patient’s oncologic care. In this review, we present the latest data on patient risk factors for developing POPF, such as obesity, smoking, young age, thick pancreas, lack of epidural anesthesia, hypoalbuminemia, and elevated drain amylase levels. Other risk factors that have been identified with irregular consistency include open surgical approach, non-malignant or neuroendocrine tumor pathology, simultaneous splenectomy, simultaneous vascular resection, and long operative time. We also review the consequences of POPF, which include hemorrhage, infection, delayed gastric emptying, re-operation, re-admission, delays in adjuvant chemotherapy initiation, reduced progression-free survival, and reduced overall survival. Finally, we present strategies that have been studied for avoiding POPF after DP, including reducing pressure at the sphincter of Oddi, the use of sealants and patches, optimizing pancreatic transection, strategies for post-operative drain placement, the use of post-operative somatostatin analogues, and pre-clinical studies of experimental devices and techniques that may inform future trials. This review informs readers on the current state of the art with regard to POPF after DP and sets the stage for future studies to improve patient outcomes. Full article
(This article belongs to the Special Issue The Progress of Pancreatectomy for Pancreatic Cancer Treatment)
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