Updated 1 November 2005

Ductal adenocarcinoma of the pancreas is occasionally resectable if it is small (i.e. under 3 cm diameter), does not involve or minimally involves adjacent organs, does not occlude or encase the superior mesenteric vasculature, and does not invade the celiac nerve plexus.

The preoperative work-up requires a CT or MRI scan, ERCP and laparoscopy.

A small subset of pancreatic tumours may present as large tumours which clinically may do well with resection. Such tumours are cystic tumours of the pancreas, giant cell tumours, osteoclastic tumours, intraductal papillary tumours and islet cell tumours. Cystic tumours may be malignant mucinous cystadenocarcinoma or mucinous cystic neoplasms, both subtypes of adenocarcinoma. In either event, they should be resected, as 5 year survival may be as high as 60%.

Carcinoma of the ampulla of Vater, the distal common bile duct, and the duodenum have a much better prognosis, and if locally confined, should be treated by pancreaticoduodenectomy in good risk patients. If a potentially resectable ampullary lesion is unexpectedly discovered at laparotomy for jaundice, the unprepared surgeon should merely terminate the procedure and transfer the patient as soon as possible.