Pancreatic Cancer: Risk Factors, Diagnosis and Minimally Invasive Surgical Approach-A Comprehensive Review

Pancreatic cancer represents a major health issue with poor prognosis. There are several risk factors related to this important disease and their control may influence its burden. The radical treatment for pancreatic cancer remains the surgery and the use of minimally invasive approach is nowadays considered optimal. The aim of the study was to analyze the pancreatic cancer characteristics and the safety and feasibility of the minimally invasive approach in treating this type of cancer. We conducted a literature review in Pub-Med database using mesh-terms for pancreatic cancer and minimally invasive surgery focusing on the short-term outcomes of and long-term outcomes of MIS. We also reviewed the most relevant literature studying the epidemiology of the pancreatic cancer, risk factors, histopathology, resectability and surgical options, the use of preoperative biliary drainage, neoadjuvant and adjuvant treatment. The most revelant risk factors associated with pancreatic cancer are represented by age, sex, area of living, blood group, genetic factors and the presence of diabetes, human microflora, alcohol consumption, smoking, chronic pancreatitis, obesity. Minimally in-vasive approach for pancreatic cancer is associated with improved intraoperative and short-term postoperative outcomes such as: reduced intraoperative blood loss, faster functional recovery, lower postoperative pain, shorter hospital stay, but similar postop-erative morbidity and pancreatic fistula risk to the open approach. Regarding oncological results, minimally invasive approach provides optimal number of harvested lymph-nodes and R0 resection rates. Minimally invasive surgery for pancreatic cancer should be performed in high-volume, specialized centers with dedicated and experimented surgeons and for selected patients.