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Surgery for pancreatic cancer

Pancreatic surgery for malignant and benign conditions is one of the areas of expertise at our Institution, which is a designated high-volume pancreatic cancer centre. Every year a large number of pancreatico-duodenectomy and distal pancreatectomy operations are performed for lesions of the head and body/tail of the pancreas respectively.

Patients with pancreatic cancer often present late with locally advanced disease, mainly due to vascular involvement. We routinely perform vascular resection and reconstruction of the portal vein, sometimes with an interposition graft taken from the internal jugular vein.

This aggressive approach has not translated into a greater morbidity; to date, we have not registered any perioperative death.

Chemotherapy, alone or in combination with radiotherapy, plays a crucial role in the management of these patients, either as a neo-adjuvant treatment to downstage inoperable tumours or delivered postoperatively to minimise the chance of recurrence (adjuvant chemotherapy).

In line with liver surgery, patients with benign cystic lesions and pancreatic neuroendocrine tumours are now operated laparoscopically. The Royal Free Hospital is also a referral centre for patients with acute and chronic pancreatitis, as well as simple or complex gallstone disease.