Pancreatic Cancer Are Resections Justified?

INTRODUCTION

Resections for pancreatic cancer have been carried out for 86 years. Doubts about the efficacy were first expressed in 1964. Resections are costly and recent reports have failed to show success. It is suggested that resections should be abandoned, but biologic research and palliation emphasized.

INCIDENCE

The incidence of pancreatic cancer has been increasing in western societies and is considered to become the second leading cause of cancer-related deaths by the year 2030 and a major burden. The incidence is estimated to be 64430 in the USA in 2021 and increase to 88,000 for both sexes in 2030. Incidence differs between ethnic groups for many cited between 10-15/100,000 but has been reported up to 20/100,000 in certain ethnic groups.

RESERVATION, NON-RESECTED SURVIVORS 

Resection for pancreatic adenocarcinoma was first attempted by Codivilla A in 1898 and then by Kausch W in 1912 [5] but was first successfully performed by Whipple A in 1935. Resections have since been carried out systematically over the last 86 years, but opinions have differed as to the results. 

The first doubts about the effect of a resection for this disease was expressed by Glenn F and Thorbjarnarson B from Cornell in 1964. They reported on 236 patients over 30-years period with 30 resections. They pointed out difficult location with adjacent major vessels and “the profuse and variable lymphatic and venous drainage of the pancreas invites early and widespread dissemination of the tumor cells”. Their only 5-years survivor was resected but then died of recurrence. They concluded that same result might have been achieved by palliative procedures and saw resection as such, offering symptomatic relief but not prolonging life to an appreciable degree and doubted cure.

CONCLUSION

Pancreatic cancer is thus both a costly and devastating disease and has usually metastasized at the time of diagnosis and treatment. Emphasis should be on biologic research and palliation. It concludes that resections are not justified and should be abandoned.

SOURCE: https://www.tridhascholars.org/pdfs/pancreatic-cancer-are-resections-justified-CMJ-S6-1007.pdf



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