Resectable pancreatic cancer
Looking forward to a new era

Leyo Ruo, MD, FRCSC

Determining the extent of disease at distant sites (e.g. liver, peritoneal and omental metastases) as well as local extension and involvement of adjacent critical structures (celiac axis and tributaries, portal and/or superior mesenteric vein and superior mesenteric artery) identifies the approximately 10% to 20% of patients eligible for surgical resection and is thus the focus of preoperative diagnostic imaging.

 

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Top-line summary
Pancreatic cancer is the fourth leading cause of cancer-related death in the western world and the second leading cause of death from gastrointestinal cancers. An estimated 3500 new cases and 3400 deaths from pancreatic cancer will occur in Canada in 2006.1 Overall 5-year survival is < 5%;2 the poor prognosis is due to high rates of advanced disease at presentation, low rates of surgical resectability, and the aggressive biological behaviour of this cancer, including high likelihood of distant micrometastases. Surgical resection is the cornerstone of potential cure, but incorporation of other treatment modalities is essential to maximize survival. A recent trend towards improved outcomes has been attributed to an increased proportion of patients undergoing surgery in specialized, high-volume treatment centres and greater use of adjuvant therapy — although the latter remains controversial. Significant improvement in survival of patients with pancreatic cancer will require better understanding of the molecular biology behind this malignancy combined with novel treatment modalities.
 
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