Adenocarcinoma of the pancreas is one of the most lethal malignancies known to mankind. In 2009, it is estimated that 42,470 cases of pancreatic adenocarcinoma will be diagnosed in the United States, and 35,240 patients will die from the disease (1). The response of pancreatic cancer to chemotherapy and radiation therapy is poor, thus complete (R0) surgical resection offers the best hope for long-term survival. Unfortunately, only 15% to 20% of all patients with pancreatic cancer will have resectable disease at the time of diagnosis. Furthermore, patients with stage I pancreatic adenocarcinoma undergoing complete surgical resection, the best possible clinical scenario, still have a 5-year survival of only 15% to 20%. This is a striking contrast to the 80% to 90% 5-year survival generally realized by patients with other common epithelial tumors (such as breast and colon adenocarcinoma) of similar stage, and attests to the intrinsic biologic virulence of pancreatic adenocarcinoma.

Over the past 2 decades, major advances have been made in the operative and perioperative care of patients with pancreatic malignancy. These advances have translated directly to the dramatic decrease in perioperative mortality and acceptable postoperative complication rates currently reported from high-volume pancreatic surgical centers. This chapter reviews the pathology and diagnosis of pancreatic tumors, and principally focuses on the current surgical therapy of pancreatic adenocarcinoma, including both curative resection and palliation.