Pancreatic surgery: evolution and current tailored approach

Surgical resection of pancreatic cancer offers the only chance for prolonged survival. Pancreticresections are technically challenging, and are accompanied by a substantial risk for postoperativecomplications, the most significant complication being a pancreatic fistula. Risk factors for developmentof pancreatic leakage are now well known, and several prophylactic pharmacological measures, as well astechnical interventions have been suggested in prevention of pancreatic fistula. With better postoperativecare and improved radiological interventions, most frequently complications can be managed conservatively.This review also attempts to address some of the controversies related to optimal management of thepancreatic remnant after pancreaticoduodenectomy.