Told it’s inoperable? Why a second opinion could change everything

22 May 2025

Hope beyond the headlines with Mr Nikolaos Chatzizacharias

A diagnosis of pancreatic cancer is devastating news, and being told that the cancer “can’t be removed” is possibly one of the hardest things a person can hear. It can feel final – and patients using Google to research their condition are met with bleak statistics and terrifying prognoses – certainly driving home that their options are gone and time is short.

But what if that isn’t always the case?

Mr. Nikolaos Chatzizacharias is one of the UK’s leading experts in the surgical treatment of pancreatic cancer. As a distinguished Consultant Surgeon specializing in hepatopancreatobiliary (HPB) and liver transplant surgery, he leads the Locally Advanced Pancreatic Cancer Programme at the Queen Elizabeth Hospital, Birmingham–the largest of its kind in the UK.

This programme evaluates the impact of neoadjuvant chemotherapy, which aims to shrink the cancer before surgical removal, on the outcomes for patients with tumours that are not initially suitable for surgical intervention.

What does ‘unresectable’ really mean?

When a surgeon consults on cancer cases, they may term tumours as ‘resectable’, ‘unresectable’, or ‘borderline resectable’ or “locally advanced”. But what does that really mean for the patient?

“Resectable tumours” are cancers that can be surgically removed with the intention of curing the patient, leaving no cancerous cells behind, known as having ‘clear margins’.
“Borderline resectable” tumours are in a ‘grey’ area where surgical intervention is possible but will require complex procedures after neoadjuvant treatment.
“Locally advanced” tumours may be operable with complex surgery after neoadjuvant treatment.
“Unresectable” tumours are cancerous tumours that cannot be removed completely by surgery due to extensive local spread or spread to different organs away from the pancreas.

The pancreas is situated deep in the abdomen, sandwiched between the stomach, spine, and small intestine. Its proximity to major abdominal blood vessels influences the feasibility of treatment for pancreatic cancer.

But that doesn’t always mean surgery is off the table for good.

Thanks to advances in imaging, chemotherapy, and specialized surgical techniques, patients once considered untreatable may now be eligible for surgery after undergoing treatment first.

Neoadjuvant Chemotherapy: A First Step Towards Surgery

Giving chemotherapy before surgery can shrink or downstage the tumour, turning some previously inoperable cancers into tumours that can be removed safely and effectively.

In Birmingham, a specialized programme has been helping patients with borderline resectable and locally advanced pancreatic cancer, and the numbers speak for themselves.

For patients with borderline resectable pancreatic cancer, 40% can have a successful resection, rising to 50% if treatment is completed. With surgery, patients live more than three times longer on average than their non-surgical counterparts.
For patients with locally advanced pancreatic cancer, 20% have successful resection, increasing to 30% if treatment is completed. This has raised the median survival to 33 months, compared to just 12 months for those receiving chemotherapy only, and 4 months for those who do not undergo treatment.

These are not just numbers–they represent real lives extended, time gained with loved ones, and hope renewed.

This is Why a Second Opinion Matters

Every hospital is different. Some centres offer treatments, including complex surgeries, that others do not. Gaining a second opinion, especially from a highly experienced surgical team, can make all the difference.

Patients who have been told nothing could be done have discovered they had options all along.

“A lot of patients contact me for a second opinion,” Mr. Chatzizacharias says, “and they are frequently pleasantly surprised with what can be offered.”

A difficult diagnosis doesn’t have to be the end of the road. There are people who can help and options you may not have heard of yet. A second opinion could change the course of your treatment and your life.

At Get Well Soon, we work with the best to ensure the treatment you receive is expert-led, evidence-based, and gives you the best possible chance at a longer, healthier life.

For more information on pancreatic cancer, you can visit Mr. Chatzizacharias’ website.