Pancreatic Cancer - Screening and Diagnosis

Why is it that only the big hospitals in the US(maybe 4 of them) willing to do a wipple for stage 4 metastisized to the liver. They will do ablations on the liver if necessary and do 12 rounds of chemo first to shrink the tumors and then do a wipple after if they are fit for it. This is the closest process to prolong stage 4 even if it gets them 3 years plus then it is worth it .Why is it that only these hospitals that are willing to go the extra mile but all others even including Canadian hospitals say ther is no hope for stage 4 and don't do anything besides chemo. It's not fair