How do you determine which patients with pancreatic cancer should be offered the option of tumor resection?

FAQ Library published on October 23, 2017
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Alok A. Khorana, MD
Professor of Medicine
Cleveland Clinic Lerner College of Medicine
Case Western Reserve University
Cleveland, Ohio
How do you determine which patients with pancreatic cancer should be offered the option of tumor resection?

Welcome to Partners in Pancreatic Cancer. My name is Dr. Alok Khorana. I am frequently asked, “How do you determine which patients with pancreatic cancer should be offered the option of tumor resection?” This is a really important question because the type of surgery that is offered to pancreatic cancer patients, typically Whipple operation (oftentimes it is still pancreatectomy), is a difficult operation. There are some comorbidities related to this that can really impact a patient’s quality of life. It is a long surgery. There can be complications afterwards, and so, you want to make sure that you are choosing the right patient for this type of operation. In our practice, we typically rely on a multidisciplinary model. What that means is that this decision to operate or non-operate on patients is not made by individual physicians, but rather by a team of physicians that includes medical oncologists, radiation oncologists, and especially surgical oncologists, as well as imaging specialists. We see patients in a multidisciplinary clinic where the patient is evaluated by each discipline, then we sort of put our heads together, either at the end of the clinic or in the form of a tumor board, where all the data are reviewed, the imaging is reviewed, the pathology is reviewed and then we come to a consensus. Is this a patient that should be offered surgery upfront? Is this a patient that should be offered something else upfront and then surgery put off until you are absolutely sure that is the right decision for this patient? It is really driven by multidisciplinary input. What factor is going to that multidisciplinary input? It is partly looking at the patient. Are they healthy enough to go through successfully an operation like this, or do they have any other comorbidities such as diabetes that needs to be managed better before we offer the operation, or what is the treatment situation like? Is their cancer so localized that we are very confident that all of it could come out and nothing is going to be left behind, or would such a patient benefit from upfront chemotherapy or chemoradiation therapy to downstage the tumor and ensure that there is no occult systemic disease that is presenting? For that, we rely also on the ASCO and other guidelines which talk about the tumor interface of the blood vessels, not having arterial involvement, having less than 180 degrees of vein involvement, not having nodes outside of the nodal base for the primary lesion and of course, having an informed discussion with patients and making sure they understand the pros and cons of upfront resection versus neoadjuvant approaches. Thank you for viewing this activity.

Last modified: October 19, 2017
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