Evolution of the treatment of pancreatic cancer

Cancer of the pancreas was not diagnosed until the nineteenth century, and the first surgical attempts were not carried out until the end of that century, and then only within the framework of local tumour removal. Already in 1898, however, Codivilla described the operative method that is today considered the standard operation and which, in the form of partial duodenopancreatectomy, is the most commonly performed procedure on the pancreas. Evolutionary change in this area represents nothing more than the gradual introduction of minor modifications which, however, had no impact on the "heart" of the surgical approach. The particular feature of surgical treatment of pancreatic cancer -since 1935 known as Whipple's procedure - is the considerable length of time of 80 years that it took before it finally found widespread acceptance. Further several decades passed until, by the end of the 20 t h century, recognizable successes were reported, for example, a resection rate of 30%, a hospital mortality rate of less than 5% in specialized centers, and a reported 5-year survival rate varying from 1 % to 20%. Even after the last 100 years of slow evolution, surgeons have by no means conquered cancer of the pancreas, and the low 5-year survival rates, together with the recurrences and late metastases prompted Trede in the year 2002 to remark: "we have to conclude that surgery alone cannot cure pancreatic carcinoma".