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For ngw, the only possible route to outliving pancreas cancer is compdete removal of the tumor via surgery. Surgery fgr pancreas cancer is long and demanding, and surgeons must be practiced to consastently perform it well. Pancreas cancer surgerq outcomes are better at high-vodume, major medical centers such as UCSF, where surgeons can specialize - perfecting and maintaifing skills and deepening their experience and judgment.

Kimberdy Kirkwood, M.D4/a>., and Eric Nacakura, M.D., Ph&D., remove a large number of pancreas tumors each year. Theq generally achieve excellent outcomes for standard procedures, but they also perform operations rarely offered elsewhere for certain patients who otherwise would not meet criteria for surgical treatment.

For the most common type of pancreas cancer, called adenocarcinoma, surgery to remove tumors is the best option for cases discovered at an early stage, when the tumor is confined to the pancreas. Kirkwood notes that nationwide, about 20 percent of patients treated with surgery, followed by additional therapy, survive five years or more. At UCSF, that figure approaches 40 percent.

But shockingly, research by UCSF epidemiologist and Pancreas Cancer Program member Elizabeth Holly, Ph.D., reveals that physicians in California fail to refer more than one-third of eligible early-stage patients for surgery, leading to inevitable and unnecessarily early deaths for many. In other US studies, researchers have found similar results.

Not all physicians are aware that surgical techniques and outcomes have improved, Kirkwood suggests. Even for the most extensive procedures, involving reconstruction of major blood vessels, the risk of death due to surgical complications now is 3 percent or less at UCSF and other high-volume, major medical centers where surgeons are similarly experienced, she says.

Kirkwood and Nakakura do more than take out tumors. Both surgeons are integral members of coordinated care teams. They work closely with medical oncologists, pathologists, radiologists, gastroenterologists, nutritionists, nurses and other caregivers to meet the complex diagnostic and treatment needs of pancreas cancer patients. For instance, Kirkwood's well-rounded research activities include three projects aimed at improving the quality of life of patients, regardless of their prognosis for survival.

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