Bilimoria KY et al. (2007) National failure to operate on early stage pancreatic cancer. Ann Surg 246: 173–180

Pancreatic cancer is the fourth leading cause of cancer deaths in the US, and fewer than 5% of all patients survive 5 years after diagnosis. Surgery is the only potentially curative treatment for localized pancreatic cancer, and studies suggest that long-term survival after resection of localized disease now approaches 30%. It has been suggested that pessimistic attitudes towards all pancreatic cancer patients might have led to skepticism regarding the value of resection.

Bilimoria et al. set out to discover to what extent surgery was being used for early-stage pancreatic adenocarcinoma, and to identify factors that could predict the failure of patients to undergo the procedure. A total of 9,559 patients with Stage I, potentially resectable tumors were identified using the National Cancer Data Base (1995–2004). Of these patients, 71.4% were found not to have undergone surgery; some were excluded, or refused surgery, but 38.2% of patients, whose outcome and survival would have been more favorable with resection, “were not offered surgery”. Surgery was less likely if patients were older than 65 years of age, black, on low-income medical insurance, or had pancreatic head lesions, low annual incomes, or low levels of education. Surgery was also less likely at low-volume and community centers.

The authors conclude that nihilistic attitudes toward pancreatic cancer are contributing to a striking underuse of potentially curative resection for pancreatic adenocarcinoma, and recommend that surgery should be offered to all appropriate patients who have resectable disease.