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 mor...

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Bibliographic Details
Published in:Journal of gastroenterology and hepatology 2008-07, Vol.23 (7pt1), p.1036-1045
Main Authors: Chang, David K, Merrett, Neil D, Biankin, Andrew V
Format: Article
Language:English
Subjects:
Attitude of Health Personnel
Biological and medical sciences
Carcinoma in Situ - mortality
Carcinoma in Situ - pathology
Carcinoma in Situ - surgery
Decision Trees
Disease Progression
Gastroenterology. Liver. Pancreas. Abdomen
Guideline Adherence
Health Services Accessibility
Humans
Liver. Biliary tract. Portal circulation. Exocrine pancreas
Medical sciences
Neoplasm Staging
outcome
Pancreatectomy - adverse effects
Pancreatectomy - methods
pancreatic cancer
Pancreatic Neoplasms - mortality
Pancreatic Neoplasms - pathology
Pancreatic Neoplasms - surgery
pancreatic surgery
pancreatology
Patient Care Team
Practice Guidelines as Topic
Practice Patterns, Physicians
Precancerous Conditions - mortality
Precancerous Conditions - pathology
Precancerous Conditions - surgery
prognosis
Quality of Health Care
Referral and Consultation
Treatment Outcome
Tumors
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Summary: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.
ISSN:0815-9319
1440-1746
DOI:10.1111/j.1440-1746.2008.05471.x