Professor of Surgery Aristotle Perrakis explains why precision, proper preparation and team strategy determine success in treatment.
The scary diagnosis
Pancreatic cancer is one of the most difficult and demanding forms of cancer.
The diagnosis is usually accompanied by fear and uncertainty, however, as he explains the Professor of Surgery Dr. Aristotle Perrakisthe progress of recent years has changed the facts:
“The point is not to act quickly, but strategically. Every decision needs precision, and preparation.”
The treatment of pancreatic cancer today is not based on speed, but on the careful evaluation of all data from the beginning. The modern approach emphasizes in personalized and multifactorial strategy, precision in staging through a complex diagnostic process, as well as logic, interdisciplinary collaboration and accurate knowledge of anatomy.
The anatomy of the pancreas – why it is a “difficult” organ
The pancreas is located in an extremely complex anatomical environment. It is flanked by critical arteries and veins — the superior mesenteric artery, the hepatic artery, the portal vein, and the inferior vena cava, which makes its surgery particularly challenging.
“The proximity of these structures means that every millimeter counts. There is no room for ambiguity.”
Knowledge of anatomy is not a theoretical detail. It is the foundation upon which the safety of any operation is based. A small mistake in planning can have serious consequences, which is why pancreatic surgery requires experience, composure and extreme precision.
From anatomy to strategy – the importance of pre-operative planning
Before a decision is made as to whether a tumor can be removed, there is a specific and demanding preoperative evaluation. This is where the strategy begins to take shape.
“The most critical step of an operation is not in the room. It is before you enter. Accuracy begins with the plan and the diagnostic pathway”
Correct staging is based on a combination of imaging modalities such as CT and MRI, endoscopic ultrasound and, where appropriate, biopsy.
These tests give a complete picture of the disease and allow the surgeon to draw up the optimal strategy.
A multidisciplinary team always participates in this stage: surgeons, oncologists, radiologists, radiation therapists and pathologists.
The decision about whether and when to operate is made through collaboration, not intuition.
The decision strategy
The strategic approach of each patient depends primarily on the relationship of the tumor to the neighboring vascular structures and on the exact stage of the disease. As Professor Perrakis explains, this classification leads to three main categories volumes:
1. Resectable tumors
These are patients in whom the tumor is immediately resectable, as there is a clear distance from the underlying vascular structures. In these cases, the operation can be performed safely and with the possibility of complete removal of the disease.
2. Borderline Resectable Tumors
In this category, the tumor either abuts or infiltrates the vascular structures in a short length and in less than 180 degrees. Here, as a rule, it is required preoperative chemotherapyso that the tumor shrinks and becomes safely operable.
3. Unresectable tumors
These are tumors that are primarily unresectable because they invade essential vascular structures either longitudinally or circumferentially through 360 degrees. At this stage, surgery is not a safe or effective option.
“The word ‘inoperable’ does not mean ‘without hope’. It means that at this stage surgery is not the best solution.”
The correct classification and, above all, the correct timing of the decision determine the success of the treatment. The goal is to perform the operation only when, and only as, the patient can actually benefit.
Experience and responsibility
A doctor’s experience is not only reflected in years or the number of operations, but in the ability to recognize when to proceed and when to wait.
It is this measure that defines pancreatic surgery today: precision, not showmanship.
Knowledge, strategic thinking and collaboration are the elements that transform a “difficult” disease into a field of hope and progress.
The pancreas is not inoperable
Professor Perrakis summarizes his philosophy with a perspective-changing phrase:
“The pancreas is not inoperable. It is demanding. And that means it takes thought, experience and a team.”
This year’s World Pancreatic Cancer Day reminds us that medical progress does not depend only on machines or techniques, but primarily on how decisions are made, through a multidisciplinary, multifactorial approach, with surgery and oncology as the main pillar and always with prudence, precision and respect for the patient.