Standard Pancreatoduodenectomy for Resectable Pancreatic Cancer

Pancreatoduodenectomy offers at present the only chance for a cure for cancer of the pancreatic head. A meticulous surgical technique, proper patient selection, an all-inclusive perioperative care and multimodal treatment approaches are essential to achieving the best possible clinical and oncologic outcomes. Open pancreatoduodenectomy is the standard surgical procedure for pancreatic head carcinoma, which can be broken down into several steps, with the three major phases exploratory, resection and the reconstruction phase. Despite numerous trials that compared diverse steps of pancreatoduodenectomy, no specific technique can reproducibly lower the relatively high morbidity and mortality rates of this complex procedure. In particular, the prevention of a clinically relevant postoperative pancreatic fistula, the most troublesome complication after pancreatoduodenectomy, remains a challenge to date. This chapter will focus on the open technique of pancreatoduodenectomy and describe the essential steps as well as variations for performing a safe resection of a cancer of the pancreatic head. Relevant references will give direction to further details, to help guide the reader through the extensive literature on this topic.