February 18, 2009 § 2 Comments
A post over at IntraopOrate reminded me of a belief I held before knowing much about surgery. Reading it also coincided with an operation I was filming this week, in which the patient’s pancreatic tumor turned out to be inoperable.
Surgery is the last resort, right? You break your ankle and the fracture is so complicated you have to have an operation. Not good. I used to think this applied to all surgery, and I guess a lot of people do. But most of the time it’s exactly the opposite that is true, especially with cancer surgery. If you can have surgery, the disease is most likely not too advanced, and you have a chance of curation. If the tumor has infiltrated too many organs and vital blood vessels, surgery can do no good. The tumor is inoperable.
The Whipple procedure (image credit) is standard surgery for tumors on the head (caput) of the pancreas. Being suited for surgery is indeed a good sign for patients with pancreatic cancer. It is one of the most aggressive forms of cancer, and is often not discovered until it has reached an advanced stage, because it often does not cause any symptoms. How advanced the disease is can however be difficult to tell before the patient’s abdomen is opened.
The patient I was filming was thought to be operable. For three hours the surgeons dissected around the tumor and discussed if they would go ahead with the resection. They finally decided the tumor was technically resectable and started to remove the gall bladder. When moving on to the small intestine however, a number of small metastases were discovered. As they examined the entire length of intestine, more and more metastases were found. It was suddenly no point in completing the operation. His pancreatic cancer was too advanced. No bridges were burnt anatomically, so there was just a matter of closing the wound. The patient will be offered a palliative chemotherapy treatment, but the median survival from diagnosis is 3 to 6 months. For inoperable patients even less.