Differences in strategies for carcinoma of the pancreas between Japan and western countries

: Differences in surgical strategies for carcinoma of the pancreas, especially the head of the pancreas, between Japan and western countries are described. In Japan, pancreatoduodenectomy (PD) or pylorus-preserving PD, accompanied by extensive lymph node and extra-pancreatic nerve plexus dissection, is performed for this difficult disease. Combined resection of the portal vein is also done when needed (radical resection). In western countries, a standard PD does not include extensive lymph node dissection and portal vein resection (standard resection). Although some Japanese surgeons reported about 30% postoperative 5-year survival rates after radical resection and some American surgeons achieved about 20% 5-year survival rates after standard resection, there are some problems with comparison of these results. Surgeons in Japan and western countries use different staging systems, namely, the classifications of the Japanese Pancreas Society and the Union of Internationale Contre le Cancer (UICC). It is essential to establish a more accurate international staging system to scientifically evaluate the difference in surgical results between Japan and western countries.