Has the time come to form specialised centres for complex surgical procedures?
The article by Speer and colleagues in this issue of the Journal reporting outcomes in patients undergoing pancreatectomy for pancreatic cancer in Victoria in 2002–2003 indicates the poor outcome for this condition on a population basis.1 Consistent with international series are the observations that only a small percentage (10%–15%) of patients have resectable disease at diagnosis; that survival is significantly improved by obtaining a clear margin; that the median survival is relatively short after resection; and that long-term cure is rare, with even some of the small number of 5-year survivors relapsing after this milestone.
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- 1. Speer AG, Thursfield VJ, Torn-Broers Y, Jefford M. Pancreatic cancer: surgical management and outcomes after 6 years of follow-up. Med J Aust 2012; 196: 511-515.
- 2. De Wilde RF, Besselink MG, van der Tweel I, et al; Dutch Pancreatic Cancer Group. Impact of nationwide centralization of pancreaticoduodenectomy on hospital mortality. Br J Surg 2012; 99: 404-410. doi: 10.1002/bjs.8664.
- 3. Neoptolemos JP, Stocken DD, Friess H, et al; European Study Group for Pancreatic Cancer. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 2004; 350: 1200-1210.
- 4. Oettle H, Post S, Neuhaus P, et al. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 2007; 297: 267-277.
- 5. Ueno H, Kosuge T, Matsuyama Y, et al. A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 2009; 101: 908-915.
- 6. Springett GM, Hoffe SE. Borderline resectable pancreatic cancer: on the edge of survival [review]. Cancer Control 2008; 15: 295-307.
- 7. Kang CM, Chung YE, Park JY, et al. Potential contribution of preoperative neoadjuvant concurrent chemoradiation therapy on margin-negative resection in borderline resectable pancreatic cancer. J Gastrointest Surg 2012; 16: 509-517.
- 8. Van Laethem JL, Verslype C, Iovanna JL, et al. New strategies and designs in pancreatic cancer research: consensus guidelines report from a European expert panel. Ann Oncol 2012; 23: 570-576.
- 9. Robotin MC, Jones SC, Biankin AV, et al. Defining research priorities for pancreatic cancer in Australia: results of a consensus development process. Cancer Causes Control 2010; 21: 729-736.
- 10. Biankin AV, Hudson TJ. Somatic variation and cancer: therapies lost in the mix. Hum Genet 2011; 130: 79-91.
- 11. Rizzato C, Campa D, Giese N, et al. Pancreatic cancer susceptibility loci and their role in survival. PLoS One 2011; 6: e27921. doi: 10.1371/journal. pone. 0027921.
- 12. Smith RA, Tang J, Tudur-Smith C, et al. Meta-analysis of immunohistochemical prognostic markers in resected pancreatic cancer [review]. Br J Cancer 2011; 104: 1440-1451.
- 13. Humphris JL, Chang DK, Johns AL, et al. The prognostic and predictive value of serum CA19.9 in pancreatic cancer. Ann Oncol 2012 Jan 11. [Epub ahead of print.]
- 14. Braat H, Bruno M, Kuipers EJ, Peppelenbosch MP. Pancreatic cancer: promise for personalised medicine? Cancer Lett 2012; 318: 1-8.
- 15. Colvin EK, Chang DK, Merrett ND, et al. Individualizing therapy for pancreatic cancer [editorial]. J Gastroenterol Hepatol 2008; 23: 1779-1782.
I am Past President and a current Board member of the ANZHPBA, a member of the ESPAC-3 study group, and Secretary General Elect of the International Hepato-Pancreato-Biliary Association.