Ask HN: Would you have a surgery that only increased 5yr survival to 25%? | Hacker News Reader

Ask HN: Would you have a surgery that only increased 5yr survival to 25%?

7 pointsQuinzel16 comments

Just asking after a grim night at work, because after some shifts I think I’d prefer to die if I was faced with a similar situation. For context the surgery I specifically have in mind is this one linked below, but I mean generally I’m curious how many people would choose to fight for what seems like rather small gains.

https://www.webmd.com/cancer/pancreatic-cancer/whipple-procedure

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Something to factor into any decision is that the 5 year survival rate is based on a cohort of individual diagnosed 5 years ago. During a period of rapid advances in treatment this data may be unduly pessimistic.

I knew someone who had this procedure. If its any help, he's still alive, and that's been +17 yrs ago. I'm not saying you or anyone else would have the same luck, but it's something to think about.

That actually really makes me happy to hear!!!

Well, I know my Dad would have gone for this - though only to increase his chances of being around to look after my mother. As it turned out, however, his cancer was too far progressed by the time an operation could be scheduled.

For anyone in that situation it's worth looking into "NanoKnife" [1] as this seems to have bought him a couple of years more than we might have otherwise expected. He outlived my mother with pretty good QoL.

Pancreatic Cancer is swift, so at least in terms of the odds, 25% chance of five years with Whipple is quite good compared to no action.

[1] https://en.wikipedia.org/wiki/Irreversible_electroporation

1. How much does it cost? Would those extra years make up for it?

2. How well would you live in those years? I think this is a huge one - many of these procedures basically end up with the patient being half dead for most of their life, but at least family members can enjoy their company and becoming caretakers for the next 5 years. There are fates worse than death, and this is one of them.

If it's 25% for little cost except pain, then sure, go for it.

25% is actually pretty good odds. That would make it a worthwhile investment.

The important part of the question is "you", as in 'Would YOU have a surgery that only increased 5yr survival to 25%?'. If you are not the one threatened, it's easy to say 'Nah. I wouldn't bother.' But when the rubber hits the road, and you have to make that life or death decision for yourself, even a 1% chance might be worthwhile.

Disclaimer, or whatever: I had to decide on a triple cardiac bypass with only a day or two to decide. I had lightly gone in for a "routine" angiogram, only to be told "We're not sure if we'll let you go home tonight. That artery could go at any time at all". Obviously I decided to go ahead with the surgery. That was 18 years ago.

The article says the 5-year survival rate without the procedure is 6%, so another way to look at the Whipple is to say it quintuples the 5-year survival rate. Without further context, it's not an easy call. What is the age of the patient? What is the patient's overall health and quality of life aside from the pancreatic cancer?

Try to find people who have actually had the surgery and get their perspective.

For any surgery, make sure to check the record of the surgeon. Is this a surgery that the surgeon has performed several times? Has the surgeon done the surgery a few times in the past 6 months?

The best surgeon for what you need is someone who has done at least 100 of the specific surgeries you need and performs them on a regular basis recently, and who is at a facility that is accustomed to the specific surgery you need.

When you select a surgeon, make sure your goals are aligned with what they are offering. Are you going for a cure, palliative, or some other thing?

You can't make an informed comparison without understanding the details between all of your potential choices. For the specific surgery you mentioned, it seems like the choice is a 6% 5-year survival rate without the surgery, versus 25% with the surgery. Now, of course, 25 is more than 6, but that doesn't tell the whole story as the risks of the procedure, the financial aspect to it, as well as the overall quality of life should also be judged.

Probably depend on staging for this disease? If I was diagnosed with pancreatic stage 4 (metastatic) disease, the ship has maybe sailed on meaningful improvements in 5 year survival. I would probably opt-in to palliative surgery to improve quality of life for the next few months if the recovery didn't seem too gruesome.

Stage 1 or Stage 2? 100%. Otherwise, you are just waiting to be stage 4 . . .

If I was almost certainly going to die within 5 years otherwise (and it looks like most people would in that circumstance without having the procedure), I'd probably do it. I hope I don't have to make such a decision for a long time, though. Really sorry you have to.

I think it could depend on your life circumstances - perhaps you have just had a child and want to increase your chances of being around long enough that they may remember you vs being older with grown up children.

Sometime the point of surgery is not survival, but relief from suffering. If the surgery relieved suffering, it might be worthwhile.

I think my perception is always a bit skewed by the fact that when I see people in the immediate time after surgery, they’re at the peak of suffering.

Surgery is not a walk in the park, and it will take months to recover.

However, the body has an almost magical way of fighting back and finding a new equilibrium if you give it a chance to do so.

100%. The worst time to ask someone if they'd recommend a surgery is in recovery. There's a reason surgeons tend to handwave away the pain management aspects of recovery during consultation.

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