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ISRN Surgery
Volume 2012 (2012), Article ID 513241, 6 pages
Clinical Study

Locally Advanced Pancreatic Head Cancer: Margin-Positive Resection or Bypass?

Department of General and Visceral Surgery, University of Freiburg, Hugstetter Street 55, 79106 Freiburg, Germany

Received 26 January 2012; Accepted 29 April 2012

Academic Editors: A. Parry and B. H. Yong

Copyright © 2012 Ulrich Friedrich Wellner et al. This is an open access article distributed under the Creative Commons Attribution License, which permits unrestricted use, distribution, and reproduction in any medium, provided the original work is properly cited.


Pancreatic cancer is a highly aggressive disease with poor survival. The only effective therapy offering long-term survival is complete surgical resection. In the setting of nonmetastatic disease, locally advanced tumors constitute a technical challenge to the surgeon and may result in margin-positive resection margins. Few studies have evaluated the implications of the latter in depth. The aim of this study was to compare the margin-positive situation to palliative bypass procedures and margin-negative resections in terms of perioperative and long-term outcome. By retrospective analysis of prospectively maintained data from 360 patients operated for pancreatic cancer at our institution, we provide evidence that margin-positive resection still yields a significant survival benefit over palliative bypass procedures. At the same time, perioperative severe morbidity and mortality are not significantly increased. Our observations suggest that pancreatic cancer should be resected whenever technically feasible, including, cases of locally advanced disease.