Only
multimodal treatment concepts may potentially improve the persisting poor prognosis of the
carcinoma of the pancreas. In specialized centres surgery has reached a high level of security with a very low level of mortality. Infiltrations of the mesenterico-portal axis are not a
contraindication to a curative oncological surgery. R0 and R1 resections should be followed by
adjuvant chemotherapy with
gemcitabine. Currently there is no evidence of benefit for a neoadjuvant
radiochemotherapy in primary resectable
carcinomas of the pancreas. The survival rates of primary resectable
carcinoma patients with neoadjuvant pre-treatment correspond to those of primary resectable
carcinoma patients with adjuvant
therapy. Due to the high perioperative morbidity, some patients do not gain access to the adjuvant
therapy within a reasonable time frame. Therefore, the significance of
neoadjuvant therapy for resectable tumours should be re-evaluated in prospective randomised trials. In about one third of the patients with primary irresectable
carcinomas of the pancreas, a radical resection can be performed after neoadjuvant
radiochemotherapy. For this patient group randomised prospective trials are urgently needed. In this context, however, only an experienced pancreatic surgeon can decide about the resectability or irresectability of a pancreatic tumour.