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Table of Contents
Vol. 25, No. 3, 2007
Issue release date: September 2007
Section title: Liver and Pancreas
Dig Dis 2007;25:285–288
(DOI:10.1159/000103904)

Pancreatic Cancer Is ‘Always Non-Resectable’

Mönkemüller K. · Fry L.C. · Malfertheiner P.
Division of Gastroenterology, Hepatology and Infectious Diseases, Otto von Guericke Medical School, University of Magdeburg, Magdeburg, Germany
email Corresponding Author

Abstract

Pancreatic cancer is characterized by its very aggressive biological behavior which makes it a rapidly disseminating and deadly tumor. Due to their initial ‘silent’ behavior, pancreatic cancers are generally diagnosed too late and at that point surgical or medical interventions are futile. The outcome of pancreatic cancer has not improved over the last decades. It is evident that only very few pancreatic cancers are potentially resectable and curable, but many times even these small cancers have poor prognostic factors. Furthermore, upon surgery many of the patients considered preoperatively to have resectable tumors are found to have non-resectable disease. The problem of pancreatic cancer is further compounded by the fact that most tumors are diagnosed in elderly, frail or chronically ill patients, which makes them poor surgical candidates, and only half or fewer of these patients can undergo surgery. The stress of surgery is poorly tolerated by many patients who either die, develop complications or are then unable to receive adjuvant chemotherapy. The bottom line is that pancreatic cancer is a very aggressive tumor. Currently, most cancers are treated by non-surgical methods, and the very few patients with tumors which are potentially resectable should be operated on in specialized, high-volume pancreatic centers.

© 2007 S. Karger AG, Basel


  

Key Words

  • Pancreatic cancer, always non-resectable
  • Pancreatic cancer, epidemiology
  • Pancreatic cancer surgery
  • Specialized referral centers
  • Curative resection, feasibility

References

  1. Li D, Xie K, Wolff R, Abbruzzese JL: Pancreatic cancer. Lancet 2004;363:1049–1057.
  2. Böhmig M, Rosewicz S: Pancreatic carcinoma. Z Gastroenterol 2004;42:261–268.
  3. Willett CG, Czito BG, Bendell JC, Ryan DP: Locally advanced pancreatic cancer. J Clin Oncol 2005;23:4538–4544.
  4. Saif MW: Pancreatic cancer: highlights from the 42nd Annual Meeting of the American Society of Clinical Oncology, 2006. JOP 2006;7:337–348.

    External Resources

  5. Eloubeidi MA, Desmond RA, Wilcox CM, Wilson RJ, Manchikalapati P, Fouad MM, Eltoum I, Vickers SM: Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg 2006;192:322–329.
  6. Brenner H, Stegmaier C, Ziegler H: Long-term survival of cancer patients in Germany achieved by the beginning of the third millennium. Ann Oncol 2005;16:981–986.
  7. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE: Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.
  8. Van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ: Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005;242:781–788.
  9. Fernandez JA, Parrilla P: What are the main errors made by surgeons in the management of pancreatic cancer? Cir Esp 2006;79:215–223.

    External Resources

  10. Postier RG: The challenge of pancreatic cancer. Am J Surg 2003;186:579–582.
  11. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.
  12. Smeenk HG, Tran TC, Erdmann J, van Eijck CH, Jeekel J: Survival after surgical management of pancreatic adenocarcinoma: does curative and radical surgery truly exist? Langenbecks Arch Surg 2005;390:94–103.
  13. Michaud DS: Epidemiology of pancreatic cancer. Minerva Chir 2004;59:99–111.
  14. Bramhall SR, Allum WH, Jones AG, Allwood A, Cummins C, Neoptolemos JP: Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995;82:111–115.
  15. Seiler CA, Wagner M, Bachmann T, Redaelli CA, Schmied B, Uhl W, Friess H, Büchler MW: Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg 2005;92:547–556.
  16. Freeny PC: Pancreatic carcinoma: imaging update 2001. Dig Dis 2001;19:37–46.
  17. Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T: Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:215–220.
  18. Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I: An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 1993;72:2118–2123.
  19. Gudjonsson B: Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting. J Am Coll Surg 1995;181:483–503.
  20. Picozzi VJ, Kozarek RA, Traverso LW: Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003;185:476–480.
  21. Stojadinovic A, Brooks A, Hoos A, Jaques DP, Conlon KC, Brennan MF: An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 2003;196:954–964.
  22. Liu SL, Friess H, Kleeff J, Ji ZL, Büchler MW: Surgical approaches for resection of pancreatic cancer: an overview. Hepatobiliary Pancreat Dis Int 2002;1:118–125.

    External Resources

  23. Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H: Pylorus-preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 2004;240:738–745.

  

Author Contacts

Klaus Mönkemüller, MD, Department of Gastroenterology,
Hepatology and Infectious Diseases, Universitätsklinikum Magdeburg
Otto von Guericke University, Leipziger Strasse 44, DE–39120 Magdeburg (Germany)
Tel. +49 391 671 3100, Fax +49 391 671 3105
E-Mail klaus.moenkemueller@medizin.uni-magdeburg.de

  

Article Information

This article is a summary of a ‘Pro and Con Lecture’. The title of the ‘Con’ Lecture was: Pancreatic cancers is always surgically non-resectable’. Session 3, 8th European Bridging Meeting in Gastroenterology and EAGE Postgraduate Course ‘Controversies in Gastrointestinal Diseases’, November 23–25, 2006, Naples, Italy.

Number of Print Pages : 4
Number of Figures : 0, Number of Tables : 1, Number of References : 23

  

Publication Details

Digestive Diseases (Clinical Reviews)

Vol. 25, No. 3, Year 2007 (Cover Date: September 2007)

Journal Editor: Malfertheiner, P. (Magdeburg)
ISSN: 0257–2753 (print), 1421–9875 (Online)

For additional information: http://www.karger.com/DDI


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References

  1. Li D, Xie K, Wolff R, Abbruzzese JL: Pancreatic cancer. Lancet 2004;363:1049–1057.
  2. Böhmig M, Rosewicz S: Pancreatic carcinoma. Z Gastroenterol 2004;42:261–268.
  3. Willett CG, Czito BG, Bendell JC, Ryan DP: Locally advanced pancreatic cancer. J Clin Oncol 2005;23:4538–4544.
  4. Saif MW: Pancreatic cancer: highlights from the 42nd Annual Meeting of the American Society of Clinical Oncology, 2006. JOP 2006;7:337–348.

    External Resources

  5. Eloubeidi MA, Desmond RA, Wilcox CM, Wilson RJ, Manchikalapati P, Fouad MM, Eltoum I, Vickers SM: Prognostic factors for survival in pancreatic cancer: a population-based study. Am J Surg 2006;192:322–329.
  6. Brenner H, Stegmaier C, Ziegler H: Long-term survival of cancer patients in Germany achieved by the beginning of the third millennium. Ann Oncol 2005;16:981–986.
  7. Birkmeyer JD, Siewers AE, Finlayson EV, Stukel TA, Lucas FL, Batista I, Welch HG, Wennberg DE: Hospital volume and surgical mortality in the United States. N Engl J Med 2002;346:1128–1137.
  8. Van Heek NT, Kuhlmann KF, Scholten RJ, de Castro SM, Busch OR, van Gulik TM, Obertop H, Gouma DJ: Hospital volume and mortality after pancreatic resection: a systematic review and an evaluation of intervention in the Netherlands. Ann Surg 2005;242:781–788.
  9. Fernandez JA, Parrilla P: What are the main errors made by surgeons in the management of pancreatic cancer? Cir Esp 2006;79:215–223.

    External Resources

  10. Postier RG: The challenge of pancreatic cancer. Am J Surg 2003;186:579–582.
  11. Wagner M, Redaelli C, Lietz M, Seiler CA, Friess H, Büchler MW: Curative resection is the single most important factor determining outcome in patients with pancreatic adenocarcinoma. Br J Surg 2004;91:586–594.
  12. Smeenk HG, Tran TC, Erdmann J, van Eijck CH, Jeekel J: Survival after surgical management of pancreatic adenocarcinoma: does curative and radical surgery truly exist? Langenbecks Arch Surg 2005;390:94–103.
  13. Michaud DS: Epidemiology of pancreatic cancer. Minerva Chir 2004;59:99–111.
  14. Bramhall SR, Allum WH, Jones AG, Allwood A, Cummins C, Neoptolemos JP: Treatment and survival in 13,560 patients with pancreatic cancer, and incidence of the disease, in the West Midlands: an epidemiological study. Br J Surg 1995;82:111–115.
  15. Seiler CA, Wagner M, Bachmann T, Redaelli CA, Schmied B, Uhl W, Friess H, Büchler MW: Randomized clinical trial of pylorus-preserving duodenopancreatectomy versus classical Whipple resection-long term results. Br J Surg 2005;92:547–556.
  16. Freeny PC: Pancreatic carcinoma: imaging update 2001. Dig Dis 2001;19:37–46.
  17. Ishikawa O, Ohhigashi H, Sasaki Y, Kabuto T, Fukuda I, Furukawa H, Imaoka S, Iwanaga T: Practical usefulness of lymphatic and connective tissue clearance for the carcinoma of the pancreas head. Ann Surg 1988;208:215–220.
  18. Kayahara M, Nagakawa T, Ueno K, Ohta T, Takeda T, Miyazaki I: An evaluation of radical resection for pancreatic cancer based on the mode of recurrence as determined by autopsy and diagnostic imaging. Cancer 1993;72:2118–2123.
  19. Gudjonsson B: Carcinoma of the pancreas: critical analysis of costs, results of resections, and the need for standardized reporting. J Am Coll Surg 1995;181:483–503.
  20. Picozzi VJ, Kozarek RA, Traverso LW: Interferon-based adjuvant chemoradiation therapy after pancreaticoduodenectomy for pancreatic adenocarcinoma. Am J Surg 2003;185:476–480.
  21. Stojadinovic A, Brooks A, Hoos A, Jaques DP, Conlon KC, Brennan MF: An evidence-based approach to the surgical management of resectable pancreatic adenocarcinoma. J Am Coll Surg 2003;196:954–964.
  22. Liu SL, Friess H, Kleeff J, Ji ZL, Büchler MW: Surgical approaches for resection of pancreatic cancer: an overview. Hepatobiliary Pancreat Dis Int 2002;1:118–125.

    External Resources

  23. Tran KT, Smeenk HG, van Eijck CH, Kazemier G, Hop WC, Greve JW, Terpstra OT, Zijlstra JA, Klinkert P, Jeekel H: Pylorus-preserving pancreaticoduodenectomy versus standard Whipple procedure: a prospective, randomized, multicenter analysis of 170 patients with pancreatic and periampullary tumors. Ann Surg 2004;240:738–745.