Surgery: a treatment option for more pancreatic cancer patients

27 Oct 2015

Pancreatic cancer has long proved the least survivable of the most common forms of cancer, in part because it tends to spread before symptoms appear. Surgery has offered the longest remissions, but for many people with advanced cancer, an operation wasn’t an option. Now, thanks to improvements in chemotherapy, radiation and surgery, even this most recalcitrant of cancers is starting to budge, says Mark Truty, M.D., a Mayo Clinic gastrointestinal surgeon.

Dr. Truty and his colleagues are now performing complex tumor removal operations on pancreatic cancer patients who in the past would have been considered inoperable and they are seeing survival times rise significantly.

“We know that patients who go through our preoperative protocol and to the operating room do significantly better than average, compared to historical outcomes. We’re looking at three- to four-fold improvement in overall survival,” Dr. Truty says.

“Surgical candidates are assessed case by case”

In roughly 15% of the patients, the cancer is isolated within the pancreas, making them clear candidates for tumor removal surgery, says Dr. Truty. In 35% of the patients, the cancer has grown outside the pancreas to involve critical blood vessels, but not yet spread to other parts of the body. Those patients too were told in the past that surgery wasn’t an option, but increasingly it is, he adds.

Whether such patients are surgical candidates is assessed case by case. They first receive chemotherapy and radiation therapy, and their health care team works with them to improve their diet and overall physical condition, an effort known as prehabilitation, before surgery is considered.

In addition, patients with complex surgeries also work with dieticians and physical therapists after their operations to speed their recoveries, and those who recover well may get more chemotherapy.


In pancreatic cancer, what types of surgery are there?

If the tumor is only in the pancreas, the type of surgery depends on where it is. If it is in the organ’s head or neck, a Whipple procedure, also known as a pancreaticoduodenectomy, removes the head of the pancreas, part of the small intestine and bile duct, and the gallbladder.

If the tumor is in the body or tail of the pancreas, a surgeon will perform a distal pancreatectomy to remove the organ’s body and tail and the spleen. Some cases can now be done laparoscopically, a minimally invasive method that usually means a faster recovery.

Recovery typically includes a week in the hospital and two months recuperating at home. However, the more complex surgeries, those in cases previously considered inoperable, sometimes pair a Mayo gastrointestinal surgeon with a vascular surgeon. Those patients are in the hospital twice as long as those with simpler surgeries; recovery at home usually takes at least three months.

More improved treatment options for the patients

Patients with more advanced cancer who have aggressive chemotherapy, radiation and complex surgery are seeing average survival times of three to four years and counting, Dr. Truty says. He has only been performing the complex surgeries for about four years, so does not yet have statistics beyond that. With the advances in treatment, up to twice as many people may be surgical candidates.

Dr. Truty hopes the improved treatment options begin to counter what he sees as a sense of nihilism among  physicians and patients, and that people who are told nothing can be done seek a second opinion.  Half of his complex surgery patients were told elsewhere that surgery wasn’t an option.

Source: Mayo Clinic

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