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Surgery In Medicine

The American Cancer Society reported the trends in five-year survival for pancreas cancer (predominately pancreatic ductal adenocarcinoma) in 2010. For the cohorts of patients 1975-1977, 1984- 1986, and 1999-2005 the five-year survival rates are a dismal three percent, three percent, and six percent respectively. This is in stark contrast to overall cancer survivals from all sites for the same time intervals of 50 percent, 54 percent, and 68 percent. This is at a time when the incidence of pancreatic cancer across the United States has not decreased and, in fact, may have increased . The traditional curative treatment for pancreatic cancer has been resectional surgery. In many patients this has necessitated a radical pancreaticoduodenectomy, with its attendant morbidity and mortality. Still, even with radical surgery the extended survival has not far exceeded 20 percent. Yet treatment of pancreas cancer in many minds remains principally a surgical event. However, there have been minute advances in the management of this disease. Reduction in mortality and morbidity of the Kausch – Whipple procedure has been substantial, with many centers now reporting less than five percent mortality. This improvement has been due to several factors, including better patient selection, better patient preparation, refined operative techniques, better anesthesia management, and improved postoperative care. Yet, undeniably, the reported reduction in perioperative risk has occurred primarily from centers with high volumes of such patients, as well as in hospitals with adequate system support, such as institution of Leapfrog initiatives, achievement of HealthGrades 5-star rating, general surgery residency programs, gastroenterology fellowships, and interventional radiology services . Introduction of adjuvant and then neoadjuvant chemotherapy and radiation therapy has produced some advantage in survival, at present, merely in terms of months, but the theoretic advantages of neoadjuvant/adjuvant treatment simply awaits the discoveries of better chemotherapeutic, targeted, and immunomodulatory agents. This will best be realized through the design and implementation of appropriate clinical trials. Importantly, though, neoadjuvant treatment has afforded an opportunity to downstage pancreatic cancer and affords at least some of these patients with borderline resectable lesions the opportunity for curative surgery. Dr. Thomas S. Helling: Pancreas Cancer: A Plea for Multidisciplinary Care
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Last date updated on June, 2014

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