Dr. Choti on the Role of Upfront Surgery in Pancreatic Adenocarcinoma

Michael A. Choti, MD, chief of surgery, Banner MD Anderson Cancer Center, discusses the role of upfront surgery in pancreatic adenocarcinoma.

There is some controversy regarding the optimal frontline treatment for patients with pancreatic cancer. There is no debate that patients with elevated CA 19-9, which indicates worse prognosis and increased risk of micrometastatic disease, should receive neoadjuvant chemotherapy. However, Choti, who prefers the use of neoadjuvant chemotherapy in all patients with pancreatic adenocarcinoma, says that upfront surgery can be considered in patients with low-risk disease or those with small, resectable tumors.

Some of the controversy stems from the idea that patients who receive neoadjuvant chemotherapy are at an increased risk of developing postoperative complications, says Choti. Moreover, it is thought that the toxicities associated with chemotherapy could decrease a patient’s fitness for surgery.

However, it is more often that frail patients become fit for surgery during their course of neoadjuvant chemotherapy. In turn, these patients could have better outcomes after surgery compared with patients who undergo upfront surgery, concludes Choti.