I see that PD is justified for ampullary tumors only. The prognosis for pancreatic head mass is poor and the results of endoscopic palliation is better without exposing our patients to high morbidity and mortality.

All the Patient with Pancreatic Neoplasia with a chance to have a R0 resection should be operated.

All Patients with Intraductal papillary mucinous neoplasm (IPMN) with high grad dysplasia should be operatated.

Because in this cases you have a chance to heal the Patient.

For Patients with metastasis or local non resectable cancer a PD is not indicated

The advances in treatment of pancreatic cancer is cero, PD in most of the cases is just a palliative procedure

Intriguing question. I will forget immediately PD if one is able to propose something more effective, or at least with same efficacy. In the meantime I consider without any doubt all resectable fit patients as candidates for PD. It does not depend on my preference, just on current evidence.

PD will certainly have its place in selected patients, maybe not for adenocarcinoma of the head of the pancreas though, in the not to distant future. The dismal results with PD for this indication is now barely better than chemotherapy. I believe that local ablative procedures, such as irreversible electroporation, will be the first hand choice in the near future. Regarding the R0 question, when a standardized meticolous protocol for hisopathology is used, R0 is somewhere around 15% only in high-volume research active centres.

PD is the only effective procedure for resectable pancreatic cancer. The long term survival is stage dependent.

I agree with the comments of Dr. Julianov, Dr. Freedman, and Dr. Award'. Although current PD, with high PJ leakage, may not be beneficial for some poor survival cancers, however there are still some improvements can be done such as technical refinements to avert PJ leakage and to reduce morbidity or mortality, early detection to improve survival rate, and adjuvant therapies to prevent micrometastases.