Surgery an option for more patients with pancreatic cancer

Volume 5, Issue 1, 2016

Summary

Complex tumor removal operations may increase survival in pancreatic cancer.

Photograph of Mark J. Truty, M.D., M.S.

Mark J. Truty, M.D., M.S.

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 hasn't been an option. Now, thanks to improvements in chemotherapy, radiation and surgery, pancreatic cancer is starting to budge," said Mark J. Truty, M.D., M.S., a gastrointestinal surgeon with the Mayo Clinic Cancer Center.

Dr. Truty and his colleagues are now performing complex tumor removal operations on patients with pancreatic cancer whose tumors in the past would have been considered inoperable — and survival times seem to be rising significantly.

"We know that patients who go through our preoperative protocol and to the operating room do significantly better than average, compared with historical outcomes. We're looking at three- to fourfold improvement in overall survival," Dr. Truty said. "In the past few years, we have done operations that were never performed before. With improved chemotherapy and radiation therapy, we're now beginning to push the envelope surgically."

According to Dr. Truty, about 50,000 people are diagnosed with pancreatic cancer each year in the U.S, and in about half of those cases, the cancer has spread to other parts of their bodies, ruling out surgery.

"Historically, only about 7 percent of pancreatic cancer patients have lived at least five years after diagnosis. In roughly 15 percent of patients, the cancer is isolated within the pancreas, making them clear candidates for tumor removal surgery," Dr. Truty said. "In the other 35 percent, 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 an option."

Whether patients are surgical candidates is assessed case by case, Dr. Truty said. Before any surgery, patients would first receive chemotherapy and radiation therapy. Their health care team would also work with them to improve their diets and overall physical condition, a process called prehabilitation.

"We then look at the whole picture," Dr. Truty said. "Not just a CT scan. We look at whether the tumor can be removed and we can achieve a negative margin — no cancer cells left around it. We assess the risk of cancer spreading from surgery and tumor marker elevation."

Patients who undergo complex surgeries also work with dietitians and physical therapists after their operations to speed their recoveries, and those who recover well may get more chemotherapy, Dr. Truty said.