Treatment decisions

The use of contrast-enhanced, helical CT allows accurate assessment of local tumor resectability. Objective CT criteria for resectability have replaced exploratory laparotomy as a means of assessing resectability. Pancreaticoduodenectomy should be considered only in patients with a good performance status (Karnofsky 70% or higher) and as part of a multimodality treatment program that includes either preoperative or postoperative chemoradiation. The modest survival rates seen with current treatments (see Table 32.4-2) (Table Not Available) argue strongly for enrollment of all patients into clinical trials evaluating new combinations of surgery, chemoradiation, and newly developed systemic agents. Published perioperative mortality rates support the referral of patients with potentially resectable disease to centers that are experienced with the operative management of pancreatic cancer and that perform at least nine major pancreatic resections per year.
National cancer institute

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