0
We're unable to sign you in at this time. Please try again in a few minutes.
Retry
We were able to sign you in, but your subscription(s) could not be found. Please try again in a few minutes.
Retry
There may be a problem with your account. Please contact the AMA Service Center to resolve this issue.
Contact the AMA Service Center:
Telephone: 1 (800) 262-2350 or 1 (312) 670-7827  *   Email: subscriptions@jamanetwork.com
Error Message ......
Invited Critique |

Treatment Decision Making in Pancreatic Adenocarcinoma—Invited Critique

David B. Adams, MD
Arch Surg. 2008;143(3):281. doi:10.1001/archsurg.2007.59.
Text Size: A A A
Published online

Extract

In 1972, when asked about the lasting effects of the French Revolution, Zhou Enlai replied, “Too soon to tell.”1 The same answer is given when questions arise about the value of updated radiologic imaging in staging and managing pancreatic cancer. Consider, for example, the year 1977. In July, Creditor and Garrett2 reported in The New England Journal of Medicine about how the innovations of CT were being introduced into clinical practice. They decried that expensive technologies were widely adopted without evidence of clinical utility. In an era when more than 40% of Blue Cross plans did not reimburse for whole-body scanning, evidence for the efficacy of CT scanning was missing.3 What was clear in 1977, however, was that current diagnostic tests for pancreatic cancer were of limited utility. Abdominal ultrasonography, pancreatic function tests, ERCP, and arteriography were the sequence of tests recommended in a prospective study from the Mayo Clinic.4 When Fitzgerald et al5 examined pancreatic cancer diagnosis, CT scanning was identified as the best test despite a false-positive rate of 40%. This is when the exploratory laparotomy really was an exploration. Let's fast forward to 2007 and ask again, What is the clinical use of CT scanning in treating pancreatic cancer? Furukawa and colleagues provide a number of useful and practical answers for physicians and patients. What they have demonstrated is that, when MDCT images show that a pancreatic cancer is probably resectable, it probably is. When a tumor is probably unresectable, it is unresectable. The advantage to patients is that they can be spared multiple evaluations with EUS, MRI, ERCP, and angiography and undergo the indicated treatment. In some patients with probably resectable disease, laparotomy can be averted with use of laparoscopy, which is a superb method for detecting miniscule liver and peritoneal metastatic disease. What is notable is that MDCT technology is superb in providing precise tumor and vascular information. Tumor extension along the superior mesenteric artery and celiac axis is better displayed using MDCT than with intraoperative assessment. Remember that resectability of pancreatic cancer is best determined preoperatively, not intraoperatively. One last question: Does MDCT have an effect on pancreatic cancer outcome? Too soon to tell.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

First Page Preview

View Large
First page PDF preview

Figures

Tables

References

Correspondence

CME
Meets CME requirements for:
Browse CME for all U.S. States
Accreditation Information
The American Medical Association is accredited by the Accreditation Council for Continuing Medical Education to provide continuing medical education for physicians. The AMA designates this journal-based CME activity for a maximum of 1 AMA PRA Category 1 CreditTM per course. Physicians should claim only the credit commensurate with the extent of their participation in the activity. Physicians who complete the CME course and score at least 80% correct on the quiz are eligible for AMA PRA Category 1 CreditTM.
Note: You must get at least of the answers correct to pass this quiz.
You have not filled in all the answers to complete this quiz
The following questions were not answered:
Sorry, you have unsuccessfully completed this CME quiz with a score of
The following questions were not answered correctly:
Commitment to Change (optional):
Indicate what change(s) you will implement in your practice, if any, based on this CME course.
Your quiz results:
The filled radio buttons indicate your responses. The preferred responses are highlighted
For CME Course: A Proposed Model for Initial Assessment and Management of Acute Heart Failure Syndromes
Indicate what changes(s) you will implement in your practice, if any, based on this CME course.
Submit a Comment

Multimedia

* * SCHEDULED MAINTENANCE * *

Our websites may be periodically unavailable between midnight and 04:00 ET Thursday, July 10th, for regularly scheduled maintenance.

Some tools below are only available to our subscribers or users with an online account.

Sign in

Create a free personal account to sign up for alerts, share articles, and more.

Purchase Options

• Buy this article
• Subscribe to the journal

Related Content

Customize your page view by dragging & repositioning the boxes below.

See Also...
Articles Related By Topic
Related Collections
PubMed Articles
Jobs
JAMAevidence.com

Users' Guides to the Medical Literature
Chapter 22.2. Decision Making and the Patient

Users' Guides to the Medical Literature
The Role of Costs in Clinical Decision Making Remains Controversial

brightcove.createExperiences();