Improving outcomes for operable pancreatic cancer: is access to safer surgery the problem?
Despite advances in the understanding and treatment of pancreatic cancer in the last two decades, there is a persisting nihilistic attitude among clinicians. An alarmingly high rate of under-utilization of surgical management for operable pancreatic cancer was recently reported in the USA, where more than half of patients with stage 1 operable disease and no other contraindications were not offered surgery as therapy, denying this group of patients a 20% chance of long-term survival. These data indicate that a nihilistic attitude among clinicians may be a significant and reversible cause of the persisting high mortality of patients with pancreatic cancer. This article examines the modern management of pancreatic cancer, in particular, the advances in surgical care that have reduced the mortality of pancreatectomy to almost that of colonic resection, and outlines a strategy for improving outcomes for patients with pancreatic cancer now and in the future.
Chang
David K
DK
Upper Gastrointestinal Surgery Unit, Bankstown Hospital, Bankstown, Australia.
Merrett
Neil D
ND
Biankin
Andrew V
AV
D001291:Attitude of Health Personnel; D002278:Carcinoma in Situ / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D003663:Decision Trees; D018450:Disease Progression; D019983:Guideline Adherence; D006297:Health Services Accessibility; D006801:Humans; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000009:adverse effects / Q000379:methods; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010348:Patient Care Team; D017410:Practice Guidelines as Topic; D010818:Practice Patterns, Physicians'; D011230:Precancerous Conditions / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D011787:Quality of Health Care; D012017:Referral and Consultation; D016896:Treatment Outcome