Pancreatic cancer surgery overlooked

[June 15, 2007]  CHICAGO (AP) -- Nearly 40 percent of patients with early pancreatic cancer who could be treated with surgery don't get the operation, dooming them to grim chances of survival, a study found.

The complicated operation is tricky but safer than previously thought and can extend life, although chances of surviving five years are still not great, Dr. Mark Talamonti, study co-author, said Thursday.

Still, about 30 percent of patients with early-stage disease who get the operation can be expected to survive at least five years, compared with less than 5 percent of early stage patients who don't get the operation, the study found.

"It is still a formidable disease, but if you're caught with early stage disease, at least there is reasonable hope" with surgery, said Talamonti, a cancer surgeon at Chicago's Northwestern Memorial Hospital and chief of surgical oncology at Northwestern University's medical school.

The study is based on an analysis of a national cancer database maintained by the American College of Surgeons, which released the results Thursday.

The researchers found that 3,644 patients out of 9,559 with early stage disease, or about 38 percent, were not offered surgery. Blacks, patients older than 65, and those with lower annual incomes and education were the least likely to be offered surgery.

"For people with potentially removable cancer not to be offered the only treatment that can potentially cure them or at least extend their lives is disturbing," said Dr. William Jarnagin of Memorial Sloan-Kettering Cancer Center in New York. He was not involved in the study.

Part of the problem likely is lack of access to centers experienced in doing the surgery, Talamonti said. Also, many doctors are unaware of improvements in the surgery, he said. Some still view it and the disease itself as a virtual death sentence, and that likely also explains why so many eligible patients aren't referred for an operation, he said.

The study will appear in the August edition of Annals of Surgery, which recently printed an early online version.

About 37,000 Americans will be diagnosed this year with pancreatic cancer, and about 33,000 of them will die, making it the fourth-leading cause of cancer death, according to the American Cancer Society.

Some 20 percent of patients are diagnosed with early stage disease, where the cancer has not spread beyond the pancreas, Talamonti said.

Nearly all patients who survive many years have an operation called the Whipple procedure. This seven- to eight-hour surgery includes removing most or all of the pancreas, part of the intestine, the entire gallbladder and part of a bile duct.

The surgery itself can be dangerous, but with advances in technique, death rates have fallen from about 25 percent in the 1960s to less than 3 percent today at some centers that do many of the operations, the study authors said.

Patients eligible for surgery generally have no detectable cancer outside the pancreas. Still, disease spread is often initially hard to spot, contributing to low survival rates even after surgery, Talamonti said.

Dr. Suresh Chari, a pancreatic cancer specialist at Mayo Clinic in Rochester, Minn., said the study results were unexpected.

"I was surprised that so many of the primary physicians don't even think of referring the patient to a major center" for surgery, Chari said.

He said Mayo does about 100 pancreatic cancer surgeries a year.

"About the only way you can ever effect a long-term cure is with surgery," he said.

On the Net:

• Annals of Surgery: http://www.annalsofsurgery.com

[Associated Press]