Review
Copyright ©The Author(s) 2021. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jun 21, 2021; 27(23): 3158-3181
Published online Jun 21, 2021. doi: 10.3748/wjg.v27.i23.3158
Pancreatic adenocarcinoma: A review of recent paradigms and advances in epidemiology, clinical diagnosis and management
Nikhil Gupta, Raghav Yelamanchi
Nikhil Gupta, Raghav Yelamanchi, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, Delhi 110001, India
Author contributions: Gupta N performed the literature review and critically reviewed the manuscript; Yelamanchi R performed the literature review and drafted the manuscript; all authors read and approved the final manuscript.
Conflict-of-interest statement: None of the authors has any conflict of interest or financial ties to disclose.
Open-Access: This article is an open-access article that was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution NonCommercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/Licenses/by-nc/4.0/
Corresponding author: Nikhil Gupta, FACS, FRCS (Gen Surg), Professor, Surgeon, Department of Surgery, Atal Bihari Vajpayee Institute of Medical Sciences and Dr. Ram Manohar Lohia Hospital, BKS Marg, Delhi 110001, India. nikhil_ms26@yahoo.co.in
Received: January 22, 2021
Peer-review started: January 22, 2021
First decision: February 28, 2021
Revised: March 3, 2021
Accepted: May 21, 2021
Article in press: May 21, 2021
Published online: June 21, 2021
Abstract

Pancreatic cancer is one of the dreaded malignancies for both the patient and the clinician. The five-year survival rate of pancreatic adenocarcinoma (PDA) is as low as 2% despite multimodality treatment even in the best hands. As per the Global Cancer Observatory of the International Agency for Research in Cancer estimates of pancreatic cancer, by 2040, a 61.7% increase is expected in the total number of cases globally. With the widespread availability of next-generation sequencing, the entire genome of the tumors is being sequenced regularly, providing insight into their pathogenesis. As invasive PDA arises from pancreatic intraepithelial neoplasia and mucinous neoplasm and intraductal papillary neoplasm, screening for them can be beneficial as the disease is curable with resection at an early stage. Routine preoperative biliary drainage has no role in patients suffering from PDA with obstructive jaundice. If performed, metallic stents are preferred over plastic ones. Minimally invasive procedures are preferred to open procedures as they have less morbidity. The duct-to-mucosa technique for pancreaticojejunostomy is presently widely practiced. The role of intraperitoneal drains after surgery for PDA is controversial. Neoadjuvant chemoradiotherapy has been proven to have a significant role both in locally advanced as well as in resectable PDA. Many new regimens and drugs have been added in the arsenal of chemoradiotherapy for metastatic disease. The roles of immunotherapy and gene therapy in PDA are being investigated. This review article is intended to improve the understanding of the readers with respect to the latest updates of PDA, which may help to trigger new research ideas and make better management decisions.

Keywords: Pancreatic adenocarcinoma, Pancreatic cancer, Chemotherapy, Chemora-diotherapy, Pancreaticoduodenectomy, Distal pancreatectomy

Core Tip: Pancreatic cancer is one of the dreaded malignancies for both patients and clinicians. This narrative review highlights the newer trends and achievements in the epidemiology, etiopathogenesis, screening, diagnosis and management of pancreatic adenocarcinoma (PDA). It is intended to improve the readers’ understanding of the latest updates of PDA, which may help to trigger new research ideas and make better management decisions. Newer screening and diagnostic techniques will help in diagnosing the patients in early stages and prognosticate them better. The newer discoveries in drugs and management protocols will help increase the survival and quality of life of the patients.