Cure is uncommon in pancreatic cancer and surgical resection,even when deemed"curative",will only result in an overall five-year survival of 10-20%,and a median survival of about 11-18 months. However,resection offers the only chance of cure in this disease,however small that may be,and prolongs the short-term survival. In non-operated patients,even with other palliative measures such as chemo-radiotherapy,two-years survival is uncommon while following surgical resection,25-40% of patients will live for two years.
It is the general consensus that mortality rates over 5% are excessive. In specialist units the mortality figures are now in the region of 2% or less and large series of patients undergoing resection without any operative deaths have been reported.
Surgical resection,although only feasible in a small proportion of patients with pancreatic cancer,provides the only chance of cure,the best palliation and maximum prolongation of life in this disease. It also allows maximum benefit from chemo-radiotherapy. Resection can now be performed safely in specialist units. Thus,every patient with pancreatic cancer,except those who are very ill or with disseminated disease at presentation,should be assessed by a specialist pancreatic surgeon. Physiological state rather than chronological age should be considered when assessing fitness for surgery. Palliative resection,although it does not prolong survival,gives good quality of life and may be considered in specialist units as an alternative to surgical bypass and endoscopic stenting in low-risk patients.
Although isolated portal vein involvement has classically been a contraindication for resection,portal vein resection can be performed safely with a low perioperative mortality rate. Importantly,overall survival is similar between patients undergoing pancreatectomy with portal vein resection and those undergoing standard pancreatic resection. Suspected isolated portal vein involvement,therefore,frequently does not preclude operability and,by itself,should not be a contraindication for pancreatic resection.
Your case is stage I [T1b,N0,M0] if portal vein is not involved i.e. best chance for cure,stageII [T3,NO,MO]if portal vein is involved i.e. resection will give her the best chance for palliation.