Invited Commentary

The reader should interpret this article after considering Japanese surgical philosophy. Foremost is Japanese surgeons' proactive surgical approach, which is most exemplified by Fujio Hanyu, MD, of Tokyo Women's Medical College, Tokyo, Japan. He recently retired from a career as a pancreatic surgeon, during which he performed more than 1000 pancreatoduodenectomies. His advice to colleagues is to "never give up." Thus, the reader will find that more than 70% of 1001 recent pancreatic resections identified within the registry for the Japanese Pancreas Society (JPS) were at least stage IV cancers (tumor had invaded contiguous organs and distant nodes were involved). All cases were pancreatic adenocarcinoma and 50% of these resections had an additional extended nodal resection that removed local, regional, and distant nodes from most of the upper abdomen. These "extended" resections in 422 patients also had resection of the portosuperior mesenteric vein or inferior vena cava. The 30-day postoperative