Chemotherapy and surgery for pancreatic cancer have improved markedly over the past decade. One of the latest advancements is the modified Appleby procedure, a technique that removes two-thirds of the pancreas, the spleen and the celiac axis. This procedure – originally created for locally advanced gastric cancer – gives new options for treatment for a disease that is seeing rapid improvements in outcomes.
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Jonathan Sham, MD, a surgical oncologist at Seattle Cancer Care Alliance (SCCA), performs the Appleby procedure at UW Medicine and joined our podcast to share his insights.
“Until recently, chemotherapies were not advanced enough to support long-term survival by treating micro-metastatic disease. Now that we have more effective chemotherapies, it justifies a more aggressive surgical approach,” says Dr. Sham. “And we’re doing a better job at selecting which patients will benefit from aggressive therapies.”
Patients need four to six months of a multimodal chemotherapy first to test the biology of the tumor.
In those who respond well, the Appleby procedure gives a new option that was not previously available.
“Our first patient who underwent this procedure is eight months out, with no evidence of disease and doing great," Dr. Sham says.
This is one example of how some patients are living longer with a disease that not long ago was almost universally fatal.
"Obviously when people hear the term pancreatic cancer, it's a scary diagnosis, but the good news is we have made a lot of headway over the past five to 10 years,” says Dr. Sham. “We used to talk to patients about a five-year survival of 10% to 20% after surgery. Now, with surgery combined with modern chemotherapy, we're talking about five-year survivals in the 40 percent to 50 percent range."
Listen to the full conversation via the media player below or your favorite podcast streaming service.
RadioMD with full transcription
