Potentially curative surgery for localized pancreatic cancer is underutilized

Surgical resection of early-stage pancreatic tumors has the potential to cure patients with this deadly disease but continues to be underutilized, according to a new national analysis. This study was presented at the Society of Surgical Oncology Cancer Symposium's 67th Annual Meeting, in Phoenix, Arizona.

Cancer of the pancreas is the fourth leading cause of cancer death in the United States and more than 35,000 Americans die from pancreatic cancer each year. The initial symptoms are nonspecific, making early diagnosis and treatment difficult.

Because the disease is aggressive and often advanced at diagnosis, conventional therapies have little impact on prognosis and outcome. Surgical resection of a pancreatic tumor is the only hope for a cure. Without resection, overall median survival is 4 to 6 months with an estimated 5-year survival rate of 0.4% to 5%.

"Surgery is potentially curative for patients with early stage pancreatic cancer but utilization has not increased over the past 22 years," said senior author Julian Kim MD, chief of Surgical Oncology at University Hospitals Case Medical Center's Seidman Cancer Center, Charles Hubay Professor at Case Western Reserve University School of Medicine, in Cleveland, Ohio. "Pancreatic cancer is a deadly disease with long-term survival less than 5% and better treatments are needed to improve survival. While not all patients with localized disease are candidates for curative resection, there is an opportunity for educating patients and physicians about the potential benefits of surgery."

The Surveillance, Epidemiology, and End Results (SEER) database was used to identify characteristics of patients who did not undergo surgery for localized pancreatic cancer and to evaluate the effects of surgery on disease-specific survival. The study population included patients from the United States who were diagnosed with SEER historic stage A localized pancreatic adenocarcinoma between 1988 and 2010.

Of 6,742 patients diagnosed with localized pancreatic adenocarcinoma, only 1,715 patients (25.4%) underwent surgery. The use of surgery did not change significantly over time. Patients were less likely to undergo surgery if they were older than 50 years, black, unmarried, or located in regions other than the east coast. Patients who did not undergo surgery had significantly worse disease-specific survival than patients who underwent surgery (6 months vs. 27 months).

"This study demonstrates the value of using the SEER database to analyze factors associated with surgery as a treatment for localized pancreatic cancer in a large number of patients over a prolonged period of time," said Kim. "Our findings underscored the underutilization of this treatment modality in patients with this disease and identify an opportunity to better educate patients and physicians about improvements in surgical outcomes."

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