Pancreatic surgery in France.

In 2006, French cancer registries showed that pancreatic cancer was ranked 14th for estimated incidence (8.7/100,000) and mortality 11.4/100,000) for men, and 12th for women (5.1/100,000 and 7.4/100,000) (age-standardized rate). Long-term survival after pancreatectomy has become a reality, albeit in only a small number of patients. A series of 30 patients who survived more than 5 years postoperatively was collected from three French institutions and was published in 2008. The results of a trial using preoperative chemoradiation in potentially resectable pancreatic adenocarcinoma (French phase II FFCD 9704-SFRO trial) suggested that some tumors are chemoradiosensitive. It further suggested that preoperative chemoradiation provides an antitumor effect, which is associated with a major histopathological response in 50% of patients. Since the quality of assessment is of major concern for surgeons and for national health authorities, there is a current prospective evaluation of the role of resection margins and lymph node invasion (with precise identification of the status of superior mesenteric artery lymph nodes and nerve plexus), and the adequacy of the surgical procedure and prognosis that is ongoing in France. The objectives of this trial are to define and standardize quality criteria for surgical resection and histopathological examination of surgical specimens.