Dr. Howard Reber on Surgical Management of Pancreatic Cancer

Dr. Reber reviewed the current principles underlying the management of pancreatic cancer. In 2014 over 46,000 new cases are expected to occur in the USA, and almost 40,000 people will die. The incidence of the disease continues to increase by about 1% a year, and by the year 2020, deaths from pancreatic cancer will be second only to those from lung cancer in this country. 85% of new cases are advanced at the time of diagnosis (designated Stage III or IV disease) and these patients are rarely operated upon. Even those with Stage I or II disease (termed "early") who are candidates for resection, have more advanced disease than is evident. Thus, although some of these patients are cured by surgical resection and chemotherapy, the median survival of most of them is less than 2 years because the cancer recurs. The specific features of each of the common operations for pancreatic cancer were explained. The standard Whipple operation or the Pylorus preserving Whipple are done for tumors in the head of the pancreas; a distal pancreatectomy that includes the spleen is done for body and tail of pancreas cancers. The operations today are done quite safely with so-called operative mortality rates at UCLA less than 1%; the 5-year survival rates are over 30%. Some time was spent describing the current management of patients with Stage III disease where the tumor is locally advanced and involves some of the major blood vessels. These patients are treated with chemotherapy and some of them respond so well to that treatment that the tumor regresses to the point where surgery and even cure becomes possible. Dr. Reber explained that further major advances in how the surgery is done are unlikely, but that improvements in survival are likely as surgery is combined with newer drugs or advances that permit earlier diagnosis.