Among major cancers in South Korea, pancreatic cancer remains one of the deadliest. The five-year relative survival rate stands at just 16.5%, meaning more than eight out of 10 patients do not survive beyond five years after diagnosis. The disease often presents no distinct symptoms in its early stages, is frequently discovered after it has already advanced, progresses rapidly and readily develops resistance to treatment. For patients, the diagnosis can be devastating, while clinicians often face the disease as one of medicine’s most formidable challenges.
Yet despite those grim statistics, physicians at Samsung Medical Center’s Pancreatobiliary Cancer Center have steadily improved outcomes. The center, staffed by 25 specialists across gastroenterology, hepatobiliary-pancreatic surgery and medical oncology, has achieved a five-year relative survival rate of 23.5% for pancreatic cancer patients. The figure exceeds the U.S. average of 13.3% and reflects years of multidisciplinary treatment and research efforts.
At the forefront of pancreatic cancer treatment and research in South Korea is Dr. Kwang-Hyuk Lee, director of Samsung Medical Center’s Pancreatobiliary Cancer Center and a professor of gastroenterology. In an interview, Lee discussed the current state of pancreatic cancer treatment and the challenges that remain in overcoming the limitations of modern medicine. The following is an edited transcript of the interview.
Pancreatic cancer is known to be particularly difficult to diagnose.
Pancreatic cancer is among the most difficult cancers to detect at an early stage. The pancreas and bile ducts are located deep within the abdomen, making them difficult to evaluate with routine abdominal ultrasound examinations. Detailed imaging studies such as CT scans or MRI are often required. Unlike stomach or colorectal cancer, pancreatic cancer generally cannot be detected through routine endoscopic screening before symptoms appear. It rarely produces early symptoms, and it progresses very quickly. As a result, even people who undergo annual health screenings may be diagnosed only after the disease has already advanced significantly. Researchers are now actively studying advanced technologies such as liquid biopsy, which may allow pancreatic cancer to be diagnosed and monitored for recurrence through blood testing.
Are there warning signs that should prompt immediate testing?
Unexplained jaundice should always be evaluated with imaging tests such as CT or MRI. Persistent abdominal pain or unexplained weight loss can also warrant further investigation for pancreatic cancer. However, by the time these symptoms appear, the disease is often already advanced.
Changes in diabetes status are particularly important. Individuals who develop diabetes after age 55 or whose previously well-controlled diabetes suddenly worsens without a clear explanation—especially if accompanied by weight loss—should consider pancreatic evaluation. Diabetes can both increase the risk of pancreatic cancer and be caused by it. Long-term smokers, patients with chronic pancreatitis and individuals with a family history should also remain vigilant. Additional testing may be warranted when pancreatic cysts detected during routine screening enlarge or develop internal nodules.
Several cancers have shown rising incidence among younger adults. Is the same trend occurring with pancreatic cancer?
Pancreatic cancer has traditionally been regarded as a disease affecting people in their 60s and 70s, but more cases are being diagnosed among younger patients. Rising obesity rates are considered one contributing factor. In South Korea, annual pancreatic cancer cases increased from about 3,800 in 2006 to about 9,780 in 2021, more than doubling over 15 years. The disease has also climbed into the nation’s top 10 most common cancers.
How much have survival outcomes improved compared with the past?
Survival has clearly improved. For many years, the national five-year relative survival rate remained around 5%, but it has now increased to 16.5%. At Samsung Medical Center, multidisciplinary care combined with high-precision proton therapy has produced a five-year relative survival rate of 23.5%. That is significantly higher than the U.S. average of 13.3%.
The improvement is also evident in clinical practice. In the past, patients with stage 4 disease were often expected to survive less than six months. Today, advances in chemotherapy mean many patients live a year to 18 months or longer. More patients are also becoming eligible for surgery after tumors shrink in response to treatment.
Samsung Medical Center’s pancreatic cancer survival rate appears remarkable. What accounts for those results?
Pancreatic cancer requires coordinated care across multiple specialties. Optimal outcomes depend on successful diagnosis, surgery, chemotherapy and long-term management. The center’s multidisciplinary team includes specialists in gastroenterology, hepatobiliary-pancreatic surgery, medical oncology, radiation oncology, pathology and radiology, all working within a patient-centered treatment framework.
The center also benefits from extensive clinical experience, including more than 7,000 pancreatic resections, more than 5,000 pancreatic cancer surgeries and over 200 pancreatic cancer operations annually. Dedicated robotic operating rooms support an active robotic surgery program.
A pancreatobiliary disease cohort established beginning in 2009 and formally launched in 2015 serves as the foundation for research involving liquid biopsy, AI-based recurrence prediction and PULSAR radiation therapy. The close collaboration among 25 specialists remains one of the center’s key strengths.
For patients who are not initially candidates for surgery, the center provides personalized radiation treatment following systemic chemotherapy and multidisciplinary review. In carefully selected patients, high-precision proton therapy is used to minimize damage to surrounding gastrointestinal tissue while targeting cancer cells. These combined capabilities have contributed to the center’s outcomes. The center’s five-year relative survival rate for gallbladder and bile duct cancers is also 39.5%, compared with a U.S. average of 21.2%.
Have treatment advances made surgery possible for patients who previously had limited options?
One of the most significant changes is the expansion of the surgical candidate population. Historically, only about 20% of patients had resectable pancreatic cancer. Today, that figure has increased to approximately 25% to 30% when including borderline resectable cases and some locally advanced patients.
Borderline tumors involving nearby blood vessels were once considered poor candidates for surgery. Today, neoadjuvant chemotherapy can shrink tumors sufficiently to improve surgical outcomes. Some patients with stage 3 or even stage 4 disease are also becoming eligible for surgery following successful systemic treatment.
How would you assess South Korea’s position in pancreatic cancer research?
South Korea has already reached a world-class level in pancreatic cancer research. Samsung Medical Center’s Pancreatobiliary Cancer Center is active not only in clinical care but also in basic science, translational research and AI-driven precision medicine.
One example is a study on AI-based spatial analysis of tumor-infiltrating lymphocyte density published last year in JAMA Surgery. The research, led by Professors Joo-Kyung Park, In-Woong Han and Ki-Taek Jang, examined why patients with seemingly similar pancreatic cancers can experience very different treatment responses and outcomes. The study was highly regarded internationally. JAMA Surgery also published a special commentary titled “The Future of Oncology Is Now” in response to the findings.
What advances do you expect to have the greatest impact over the next decade?
The most promising development is early detection. Samsung Medical Center is conducting multimodal AI research that integrates liquid biopsy omics data with imaging data. The goal is to identify high-risk patients through blood testing and AI analysis, improving early diagnostic accuracy.
In treatment, next-generation adaptive radiation technologies such as PULSAR, which adjust radiation doses in real time based on tumor changes, are expected to play a major role. Continued advances in AI-assisted robotic surgery are also anticipated. New therapies targeting KRAS mutations, one of the most common genetic alterations in pancreatic cancer, are producing encouraging results.
As liquid biopsy, AI, immunotherapies, targeted therapies and personalized medicine continue to advance, physicians expect to provide more effective and safer treatment options tailored to individual patients.