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Refining the care of patients with pancreatic cancer: the AGITG Pancreatic Cancer Workshop consensus

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Pancreatic adenocarcinoma is the 11th most frequent cancer in Australia.1 The disease has a poor prognosis: the overall 5-year survival rate is about 4%, and 5-year survival in those who are eligible for surgery is 20–21%,2 which is significantly better than the 5-year survival rate of 3% for people with metastatic disease. Internationally, about 20% of patients have potentially resectable disease after staging; there is currently no strategy for early detection. Recent Australian data indicate that about 15% of patients with pancreatic adenocarcinoma undergo surgery.3

Modern imaging techniques have improved diagnostic precision, especially in differentiating adenocarcinoma from non-malignant pancreatic masses (pseudo-cyst, lymphoma, chronic pancreatitis, intraductal papillary mucinous neoplasms, neuroendocrine tumours). Important prognostic indicators for long term patient survival include negative or tumour-free surgical margins, as well as tumour size, lymph node status, and the absence of metastases.46 Margins, number of lymph nodes identified (and examined) and accurate determination of tumour size are influenced by the quality of surgery and the surgical definitions used. The lack of widely accepted clear and precise definitions of surgical margins,…