Despite the increased risk, patients whose pancreatic cancer tumor has grown to encompass critical blood vessels can be candidates for surgery. Data on efforts to fine-tune a protocol for these patients were presented at the Society for Surgery of the Alimentary Tract (SSAT) 57th Annual Meeting.1
Approximately one-third of patients with pancreatic cancer have critical blood vessels encompassed by the tumor. Although conventional wisdom has long held that tumor resection is rarely an option and life expectancies are measured in months, this research team developed a protocol for treating these patients.
“We’re definitely seeing a revolution,” said Mark Truty, MD, a gastrointestinal surgical oncologist at Mayo Clinic in Rochester, Minnesota, and senior author of the study. “A lot of this has to do with better chemotherapy drugs and use of multimodal therapy: chemotherapy, radiation, and then an aggressive operation. Now we can potentially offer these therapies to patients who previously were told they had no options.”
Pancreatic cancer is diagnosed in an estimated 50 000 people each year in the United States. Historically, only approximately 7% of patients with pancreatic cancer live at least 5 years after diagnosis.
A major challenge with pancreatic cancer is its tendency to spread before symptoms manifest; therefore, the cancer is found early enough for surgery to be a clear-cut option in only 15% of patients with the disease. Approximately half the patients’ cancer has metastasized throughout the body by the time it is diagnosed, ruling out surgery.
For this study, the researchers analyzed surgical outcomes from the past 25 years for patients with stage 3 disease who underwent surgery requiring removal and reconstruction of arteries. They found that most of the operations on this group were performed in the past 5 years, since the advent of improved chemotherapy and radiation.
Although these procedures carry more risk than operations that do not require removal and reconstruction of arteries, a significant long-term survival advantage was seen among patients whose treatment included chemotherapy and/or radiation prior to the aggressive operation. Those who underwent surgery without chemotherapy or radiation first did not do well over the long term, the researchers found. Looking at short-term outcomes, they found that complication rates have decreased over time.
“All in all, it shows that these patients, who would typically not be offered an operation, can have good short-term and long-term results with the appropriate protocol and treatment sequence,” Truty explained.
“Not everyone wants to sign up for these big operations or these long protocols of chemotherapy and radiation. But they have the options available to them to make that educated decision about whether this is something that would benefit them,” Truty said. “We’re offering an additional bit of hope for a pretty substantial number of patients who had previously been ignored.”
1. Tee MC, Farnell MB, Kendrick ML, et al. Pancreatectomy with concomitant/en bloc arterial resection: predictors of morbidity and mortality. Presentation at: SSAT 57th Annual Meeting; May 21-24, 2016; San Diego, CA.