This article details complications occurring after pancreatectomy. Morbidity following pancreatectomy is high, and failure to rescue can lead to mortality. Complications can happen early (≥30 days) or late (<30 days). Nonoperative management of complications has become first line.

Projected to be the second leader cause of cancer death in the United States by 2030, pancreatic ductal adenocarcinoma (PDAC) is an aggressive malignancy with a rising incidence. With ever-improving multimodal neoadjuvant treatment strategies, and ever-expanding definitions of resectability, more patients with borderline resectable pancreatic cancer (BRPC) and locally advanced pancreatic cancer (LAPC) are undergoing curative-intent surgery than ever before. Herein, we will define BRPC and LAPC, and then review the evidence for neoadjuvant chemotherapy, chemoradiation, and surgical management strategies. Lastly, we will describe the standardized Mayo Clinic approach to PDAC that centers 3 key principles: responsivity, reconstructability, and recoverability.

Pancreatic cancer (PDAC) is one of the most lethal malignancies. The current mainstay therapy for metastatic disease is cytotoxic chemotherapy. The increasing application of molecular profiling and precision oncology plays a significant role in the emergence of investigational targeted therapies. To date, there are a small number of targeted therapies that are FDA-approved and/or endorsed by guidelines. Major emerging targets in PDAC are KRAS, claudin, MTAP, and others. This review provides a brief overview of FDA-approved or guideline-endorsed targeted therapies and summarizes major emerging therapies in the field that are deemed to have high potential to improve outcomes in PDAC.

This article presents an overview of disparities in pancreatic cancer care using previous collated reviews and gathered evidence from national databases, prospective cohort studies, and genetic analyses to examine how these disparities manifest throughout the cancer care continuum. The article explores how both traditional multivariate and novel analytical frameworks are being used to characterize disparities at patient, provider, and health care system levels, concluding with evidence-based interventions to address these persistent inequities in clinical practice.

Pancreatic cancer is a highly aggressive disease with a poor prognosis. In advanced stages, symptoms such as biliary and gastric outlet obstructions frequently occur and can be managed through techniques such as advanced endoscopy, interventional radiology, and surgery. A multidisciplinary team, including oncologists, gastroenterologists, surgical specialists, and palliative care providers, is crucial to tailor and select treatment strategies that align with the individual goals and preferences of each patient.

This article provides a narrative review of the current state of pancreatic cancer imaging, as well as recent advancements in imaging technology, protocols, and interpretation as they relate to clinical management. The focus of this article is on the role of imaging in the diagnosis and evaluation of surgically resectable pancreatic ductal adenocarcinoma.

Pancreatic adenocarcinoma carries a poor prognosis. Throughout the course of the disease and its management, patients experience a variety of symptoms that significantly affect their quality of life. It is paramount that palliative care is integrated early in the management of pancreatic adenocarcinoma. Several options exist for symptom control, and these can be employed concomitantly with palliative strategies to provide best supportive care to patients and ultimately improve quality of life.

Pancreatic cancer is an aggressive disease with demanding therapies. Patients often present physically and nutritionally debilitated and then are required to undergo rigorous chemotherapy and/or chemoradiation, as well as operative interventions. Ensuring that patients are physically, nutritionally, and psychosocially supported may promote tolerance of neoadjuvant treatments to ensure progression to and success of surgery.

Systemic therapy is recommended for all patients with pancreatic cancer. The sequencing of chemotherapy prior to surgery results in more consistent delivery of intended therapy, allows for assessment of treatment response, identifies patients at risk of early metastatic progression, and is associated with improved pathologic outcomes. Current management and controversies, including the role of neoadjuvant chemotherapy for anatomically resectable disease, are discussed herein.

Over the last two decades, the introduction and dissemination of robotic surgery has opened the field for minimally invasive pancreatectomy. As robotic distal pancreatectomy and pancreaticoduodenectomy have become more common, there is increasing literature to support that robotic pancreatic surgery is not only technically feasible but also safe and oncologically equivalent to an open approach with improved perioperative outcomes. In this article, the authors survey the existing literature for robotic pancreatectomy and detail the approach to oncologic pancreatic resection.

Distinguishing chronic pancreatitis (CP) from pancreatic ductal adenocarcinoma poses a significant diagnostic challenge given overlapping symptoms, risk factors, and imaging findings. Misclassification can result in delayed oncologic treatment or unnecessary resection. Advances in diagnostic modalities have improved diagnostic accuracy, but there is still limited ability to differentiate these diagnoses with certainty in certain cases. Multimodal diagnostic approaches, combined with multidisciplinary evaluation, are critical to guide management. Current guidelines focus on screening high-risk patients, emphasizing the importance of clinical judgment, and maintaining a high level of concern for malignancy in ambiguous cases to optimize patient outcomes.

While the clinical benefits of adjuvant chemotherapy are well documented in resected pancreatic ductal adenocarcinoma regardless of surgical margin status, the role of adding chemoradiation to adjuvant chemotherapy is an ongoing debate due to the paucity of clinical studies that concurrently incorporated contemporary chemotherapy regimens such as mFOLFIRINOX or gemcitabine/capecitabine with modern day radiation dose fractionation and techniques. Adjuvant chemoradiation should be tailored to individual patients and supported by multidisciplinary discussion. In R1 patients with good performance status following completion of adjuvant mFOLFIRINOX or gemcitabine/capecitabine, adjuvant chemoradiation may be considered with the intent to decrease the risk of local recurrence.

Sublobar resection can be performed in selected patients with early stage nonsmall cell lung cancer with noninferior oncologic outcomes to lobectomy. Resection with surgical margins ≥2 cm or greater than the maximal tumor diameter, as well as station-based lymph node sampling or dissection of at least 3 mediastinal and one intrapulmonary or hilar lymph node, should be performed. Conversion from sublobar resection to lobectomy should be considered in patients with evidence of nodal metastasis on intraoperative frozen sections. In patients found to have occult nodal disease after resection, adjuvant systemic therapy is indicated.

Lung cancer remains the leading cause of cancer-related mortality globally, underscoring the persistent need for transformative innovations in early detection and treatment modalities. We have come a long way in lung cancer treatment over the last decade. There has been substantial improvement in treatment outcomes and survival from lung cancer thanks to advancements in implementing screening programs, improvements in surgical techniques, innovative post-operative care, and novel protocols for adjuvant and neo adjuvant targeted-treatments. This article focuses on innovations in surgical techniques and post-operative care.

Lung cancer significantly affects patients' physical health and emotional well-being, with survival rates remaining low despite advancements in treatment. While traditional clinical trials often overlook patient experiences, the focus is shifting toward patient-centered care, emphasizing patient-reported outcomes. This article highlights the growing importance of these groups and the need for integrating innovative technologies to improve patient support and communication especially in the surgical setting, where still the concept of advocacy has not yet been widely adopted.

Locally-advanced non-small cell lung cancer benefits from multimodal treatment approaches, with surgery playing a pivotal role. Advances in diagnostics and neoadjuvant therapies have increased complete resection rates and expanded surgical indications, even for previously unresectable cases. Resectability assessment requires precise staging, experienced surgical expertise, and multidisciplinary collaboration, especially in complex scenarios involving T4 tumors or N2 lymph nodes. High-volume specialized centers are crucial for optimal outcomes. Key challenges include defining resectability, minimizing surgical complications, and determining the best strategies for integrating surgery into evolving treatment paradigms, highlighting the importance of tailored multidisciplinary care.

Epidemiologic data have significantly influenced lung cancer surgery, guiding clinical decisions from screening to multimodality treatment options to perioperative care. This article highlights the role of epidemiologic studies in lung cancer treatment with a specific focus on thoracic surgery. We explore thoracic surgical practices, the impact of epidemiology on public health and policy, disparities and inequities faced by the community, and future directions and emerging trends. By providing a population health perspective, epidemiology enables thoracic surgeons to make objective, evidence-based decisions in their clinical practice.