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Pancreatic cancer in Saudi Arabia.

I read with interest the article on pancreatic cancer in Saudi Arabia treated at a tertiary institution. AlGhamdi et al1 retrospectively reviewed 179 patients with documented pancreatic cancer over a 10-year period (2000-2010), and found an overall survival to be 39% (one-year), and 10% (5-year). As mentioned by the authors, pancreatic cancer accounts for 1.75% of all cancers, and is the fifth gastrointestinal cancer affecting Saudis.2 Although one of the article objectives was to look at the treatment of pancreatic cancer in a tertiary institution, the authors did not mention the surgical treatment except that 37% of their patients were suitable for surgical resection at presentation. As we all aware, surgery is the mainstay of cure in pancreatic cancer, and inclusion of surgical treatment in the results would have been interesting. We have retrospectively analyzed our pancreatic cancer patients who were treated in our hepato-biliary unit over the first 3 years of its establishment. Unlike AlGamdi’s study,1 our study concentrated on those who underwent pancreatico-duodenectomy (PD).3 Over 3 years (2006-2009), of the 102 patients diagnosed with pancreatic cancer, only 32 (31.4%) patients (16 males and 16 females) with a mean age of 59.5 years had PD. In this cohort group of patients, jaundice was the most common presenting symptom (90%), followed by weight loss (50%), and abdominal pain (47%). Approximately 50% of our patients had comorbid diseases, mainly diabetes and hypertension. The cumulative overall survival was 80%, and disease-free survival was 82.3%.3 This confirms that the surgical resection offers a better one-year survival rate. Unfortunately, the available published data on pancreatic cancer and its treatment options in Saudi Arabia is scanty; it consists mainly of retrospective studies from some tertiary centers. The time has come for tertiary centers treating this cancer to consolidate efforts in conducting a well-structured multiinstitutional prospective study with clear aims and objectives. It is only then that we can rely on our own data that is applicable to our disease; a disease that may differ in its behavior, and natural history from that of the West. When the time comes for that to happen, it is only then, we can speak regarding pancreatic cancer in Saudi Arabia with greater confidence and solid scientific foundation. Abdul-Wahed N. Meshikhes Department of Surgery King Fahad Specialist Hospital Dammam, Kingdom of Saudi Arabia