What Is the Frequency and Impact of Patients Seeking Second Surgical Opinion for Pancreatic Cancer?

Quinn PL, Nikahd M, Saiyed S, et al. Surgical Second Opinion for Pancreatic Cancer Patients. J Am Coll Surg. 2024; in press.

Reames BN. Second Surgical Opinion for Pancreas Cancer: Resectability May Be in the Eye of the Beholder. J Am Coll Surg. 2024; in press.

Quinn and coauthors used data on patients diagnosed with pancreatic cancer (PDAC) from a national Medicare database (2013–2020) to determine the frequency of patients seeking a second surgical opinion (SSO) and the impact of SSO on rates of pancreatectomy and postoperative outcomes.

Pancreatectomy was performed in 9.2% of the total cohort (n = 116,072). SSO was obtained in 4,913 patients, and 17.9% of these patients underwent pancreatectomy; the initial surgeon performed pancreatectomy in 39.7% of this group.

Perioperative mortality was higher for pancreatectomy performed by a second surgeon (5.5% vs 2.5%); hospital length of stay and rates of complications were similar in the SSO and no SSO groups.

The authors noted that the database used in this study did not provide information on preoperative imaging results or long-term outcomes. Patient-specific data on the reasons for seeking SSO were not available.

They concluded that patients receiving SSO were more likely to undergo pancreatectomy.

Useful perspectives were included in the editorial by Reames that accompanied the article. The author noted that increased use and effectiveness of neoadjuvant therapies have made accurate staging more complex, and rates of pancreatectomy with vascular resection have increased as surgeons use operative techniques to increase PDAC survival. Because of these and other factors, multidisciplinary team management of patients with PDAC has become an essential feature of care for patients with PDAC.