Pancreatic Cancer: 80 Years of Surgery—Percentage and Repetitions

Abstract

Objective. The incidence of pancreatic cancer is estimated to be 48,960 in 2015 in the US and projected to become the second and third leading causes of cancer-related deaths by 2030. The mean costs in 2015 may be assumed to be $79,800 per patient and for each resection $164,100. Attempt is made to evaluate the results over the last 80 years, the number of survivors, and the overall survival percentage. Methods. Altogether 1230 papers have been found which deal with resections and reveal survival information. Only 621 of these report 5-year survivors. Reservation about surgery was first expressed in 1964 and five-year survival of nonresected survivors is well documented. Results. The survival percentage depends not only on the number of survivors but also on the subset from which it is calculated. Since the 1980s the papers have mainly reported the number of resections and survival as actuarial percentages, with or without the actual number of survivors being reported. The actuarial percentage is on average 2.75 higher. Detailed information on the original group (TN), number of resections, and actual number of survivors is reported in only 10.6% of the papers. Repetition occurs when the patients from a certain year are reported several times from the same institution or include survivors from many institutions or countries. Each 5-year survivor may be reported several times. Conclusion. Assuming a 10% resection rate and correcting for repetitions and the life table percentage the overall actual survival rate is hardly more than 0.3%.

The actual 5-year survivors of pancreatic ductal adenocarcinoma based on real-world data

“…Although 5-year survival rates of up to 30–58% in resected pancreatic cancer patients have been reported, the data for actual 5-year survival are more modest 3 . Several series have failed to present any 5-year survivors and there are those that suggest that the overall actual survival rate is below 0.3% when all stages are combined 4 , 5 .…”

Actual Five-year Survival After Upfront Resection for Pancreatic Ductal Adenocarcinoma

“…Critics have pointed out that in a very aggressive cancer such as PDAC the Kaplan-Meier method may dramatically overestimate long-term survival, and have repeatedly questioned published 5YS rates after resection of PDAC 6,7 . Some authors have put forward own calculations, concluding that actual 5YS after resection for PDAC is less than 10% or may even not exist 6,7 . On the other hand the few available single-institutional series report actual 5YS of 12%–19% after resection for PDAC 8,9 .…”

Thirty‐day complication rates do not differ by race among patients undergoing pancreaticoduodenectomy for pancreatic adenocarcinoma

“…Fourth, this study only analyzed patients who underwent resection; these results cannot be applied to patients not considered candidates for resection due to either patient factors or oncologic criteria. The percentage of patients undergoing resection for PDAC has increased to approximately 20% in recent years; however, the results of this study cannot be extrapolated to the 80% of patients who are not surgical candidates 53 . Finally, it is notable that the subgroup of Black patients in our study cohort is only 8.2% of the total study population, which is less than the percentage of Blacks in the general U.S. population (13.4%), according to the United States Census Bureau.…”