Pancreatic Adenocarcinoma Surveillance Counterpoint: USA

Abstract

Pancreas cancer remains a formidable challenge with an overall 5-year survival rate of <5 % [1]. Patients typically present with advanced disease at diagnosis which precludes potentially curative therapy. Only 10–12 % of patients present with localized disease and eventually undergo surgery with curative intent [2]. Although the primary aim of surgical resection is cure, only 9.8 % of patients who undergo curative-intent surgery survive >5 years; by 10 years, >3 % are survivors [3]. By observing continued patient attrition with longer follow-up, Trede et al. state that ductal adenocarcinoma of the pancreas is an incurable disease [4]. As such, pancreaticoduodenectomy for adenocarcinoma of the pancreas appears to be a palliative procedure which confers survival advantage in comparison to other available options. This is my opinion, as well, since we rarely see long-term survivors. Survival is dependent on multiple factors, including the biology of the disease, the success of the surgical intervention, and the choice of appropriate adjuvant therapy. Surgical intervention is likely to be more successful in prolonging life if an R0 resection (complete resection with no microscopic residual tumor) is achieved with minimal morbidity [5]. The more experienced the center where the surgery is performed, the higher the likelihood of minimal morbidity and maximal survival benefit [6]. Regionalization of care (referring patients to high-volume centers) represents a strategy that could improve outcome for patients with localized pancreas cancer.