Guntars Pupelis
The collected knowledge about diseases of the pancreas has changed much of the surgical strategy in the field of acute and chronic inflammation and oncologic conditions. Global cooperation has prepared the ground for a consensus regarding the treatment strategies. These involve the recovery of microcirculation and organ function in the acute phase, followed by focusing all efforts to localize the process with a strong indication to intervene when sepsis complicates the clinical course of acute pancreatitis. In the case of chronic pancreatitis, the strategy includes the selection of indications for surgical or endoscopic intervention at the right time and for the right patient. However, slower progress has been observed in the treatment of oncologic diseases when its success over the last decades is assessed critically. Timely preoperative recognition of the oncologic conditions and the selection of patients who are in dire need of advanced surgical treatment are closely associated with the necessity for high-level technical skills; nevertheless, the expectation given to the patients is not very promising. All efforts directed towards an individualized approach that includes an early recognition of the disease, multifactorial markers, improved visual diagnostics, planning of the preoperative treatment and an appropriate selection of the surgical strategy lead to a multidisciplinary model of treatment, and all research and publications concentrated on that issue add hope for a better cure.
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