Pancreatic cancer is one of the most frightening oncological diseases. But thanks to the most advanced diagnostic means, today the neoplasm is recognized more and more in advance and when it is still technically removable, through very complex interventions.

Even today, pancreatic cancer is one of the oncological diseases with the most negative prognosis. It is not really a unique problem, but there are different forms of it, both benign and malignant. Until recently, most malignant diseases were diagnosed when there was no longer any possibility of treatment. Thanks to the most advanced diagnostic methods, the neoplasm is recognized more and more in advance and when the lesion is still small and technically removable. Pancreatic operations are among the most complex of all, which is why it is important that they are carried out in highly specialized centers. “These operations can last up to seven hours and are particularly difficult because the pancreas is positioned deep in the abdomen in close contact with the stomach, intestine, spleen and some very important vascular structures,” says Alessandro Zerbi, Head of the Department of Pancreatic Surgery at Humanitas.

“Furthermore, it is a particularly fragile organ, producing corrosive substances for other tissues. The risk of complications, even fatal ones, is therefore very high and it is linked not only to the pathology, but also to the surgical technique itself. For this reason it is important that teams that have acquired a great deal of specific expertise carry out the operation. In the most specialized centers, in fact, the number of interventions can reach up to one hundred per year. Dr. Alessandro Zerbi has recently assumed this role in Humanitas within the General Surgery Operating Unit III directed by Prof. Marco Montorsi and he is one of the leading Italian experts in this field, with extensive experience gained at the San Raffaele Hospital in Milan, alongside Prof. Valerio Di Carlo, who in Italy is one of the absolute reference points for pancreatic surgery. “In dealing with such important pathologies, which are in a truly delicate position in the body, it is absolutely crucial that there is a strong synergy between the specialists involved”, explains Alessandro Zerbi.

“In these cases we work closely with the radiologist, oncologist, endoscopist, anesthesiologist, gastroenterologist and anatomopathologist, with whom we build a diagnostic and therapeutic path tailored to the patient, with the help of the most advanced technologies. For example, we use ecoendoscopy for diagnosis, a method that for the patient is similar to a normal gastroscopy but that allows us to introduce an ultrasound probe into the stomach with which we can study the organs concerned with greater precision. Advanced imaging and careful case analysis by the team of physicians allows us to identify the patients for whom surgery is most appropriate. Improved surgical techniques have shortened the post-operative period and extended the age of patients undergoing surgery beyond 80 years.

“Research has a key role to play in the progress made in this area and there is still much to be done because it is a disease that has not yet been fully understood. More and more attention is being focused on the interaction between these tumors and the immune system, a field of research in which Humanitas has great expertise and with which there are important possibilities for synergy,” adds Alessandro Zerbi, who also holds the role of National Secretary of the Italian Association for the Study of Pancreas, who coordinates several multicenter studies and has contributed to the drafting of many guidelines for many diseases. “Together with oncologists, for example, we have identified the cases in which chemotherapy can be particularly useful before and after surgery. The effectiveness of these solutions is further confirmation of how important it is to adopt an integrated approach in tackling these diseases”, concludes Alessandro Zerbi.