In The United Stated, Pancreatic Cancer is the fourth leading cause of cancer deaths as year 2007. Their National Cancer Society estimates that over 37.000 patients will be diagnosed with pancreatic cancer and 33.000 die of this disease. It still strong pessimism remains in line with the effectiveness of surgery though studies demonstrating many improved results. In this article the experts objective was to evaluate the utilization of surgery in early stage as to identify factors predicting failure to undergo surgery.

They used 9559 data patients which were identified with potentially resectable tumors (stage I : T1N0M0 and T2N0M0), and used multivariate models to have their objective accomplished.

It has been known that surgery is the only potentially curative treatment of localized pancreatic cancer. The significant advances in perioperative evaluation, surgical technique, and postoperative care can reduce its perioperative morbidity and mortality of this disease. Because of mostly clinicians assumed that diagnosis of pancreatic cancer encompasses little variability in long term results, these attitude have affected utilization of surgery for early stage pancreatic cancer after controlling variables for age, comorbidities, and patient refusal to undergo surgery. This study describes that despite better result after pancreatectomy, a half of early stage patients did not undergo surgery for presumably resectable pancreatic malignancy and about one third of patients with potentially resectable pancreatic cancer were simply not offered surgery.

Interestingly, over the past decade the mean age of patients undergoing surgery and not offered surgery remained unchanged. Study of pancreaticduodenectomy stated that patients over 85 years and older can be undergo surgery safely as they do show an increase in morbidity and mortality with increasing age. They also found an intriguing finding that patients more likely to receive surgery for lessions in the tail compared with the head or body of pancreas. Numerous studies have demonstrated improved surgery’s safety for lessions in the head of pancreas as they also did on their work previously-similar results for surgery regardless of lession location within pancreas.

Finally, they found that early stage patients selected to undergo surgery had significantly improved survival compared with the older stage (Stage III/IV). The interesting finding was, altough it may be just theorize that patients not offered surgery simply had their stage recorded in the cancer registry, the survival data tell a clear diffrence between these potentially resectable patients who were not offered surgery and those who underwent one, implying that these patients initially had disease that potentially resectable.

As conclusion, patients are required to have a detailed explanation regarding why they didn’t receive such as therapies,  and “not offered” is not an acceptable justification. The explanation of underuse of pancreatectomy may be established by implementing such mechanism for this pancreatic cancer where the database of registry can provide a clear narrative explain why the patient failed to undergo surgery thus giving a better understanding of the not offered surgery class. Surgical resection is the only opportunity for an early stage of pancreatic cancer and there is a chance to improve care of patients (in the United States) by offering pancreatectomy to all appropriate patients with resectable pancreatic cancer.

The author of this journal were Karl Y. Bilimoria, MD, David J. Bentrem, MD, Clifford Y. Ko, MD, MS, MSHS, Andrew K. Stewart, MA, David P. Winchester, MD, and Mark S. Talamonti, MD from  the Department of Surgery, Feinberg School of Medicine, Northwestern University, Chicago, IL; National Cancer Data Base, Cancer Programs, American College of Surgeons, Chicago, IL; Department of Surgery, University of California, Los Angeles (UCLA) and VA Greater Los Angeles Healthcare System, Los Angeles, CA; and Department of Surgery, Evanston Northwestern Healthcare, Evanston, IL.

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