Background and Aims: Pancreatic and periampullary cancers are sometimes found to have a too advanced disease during surgery to allow resection. The aim was to describe characteristics, treatment, outcome, and time trends for patients that were planned for pancreatic surgery but found unresectable during surgery. Material and Methods: Data from the Swedish National Pancreatic and Periampullary Cancer Registry were used. All patients registered between January 2010 and August 2018 were included. The patient cohort was divided in two halves based on year of diagnosis. Results: In total, 12,377 patients were included in the registry and finally 4568 patients were scheduled for surgery. During surgical exploration, 3879 (84.9%) patients underwent pancreatic resection, 658 (14.4%) patients were found unresectable, and 31 (0.7%) had no pancreatic resection due to other reasons (e.g. benign lesion, comorbidity). More patients underwent surgical exploration and resection during the second time period, but exploration without resection was unchanged (15.7% vs 13.7%; p = 0.062). Survival rates were lower among the unresectable patients with pancreatic and periampullary tumors compared to the resectable patients, including 30-day mortality (n = 17 (3.5%) vs n = 39 (1.6%), p = 0.004) and 90-day mortality (n = 72 (15.0%) vs n = 70 (2.8%), p < 0.001). Palliative surgery became less common during the second half of the time period (p < 0.001). Conclusion: Unresectability is associated with an unfavorable prognosis. The frequency did not decrease during the study period, but palliative surgical procedures became less common.
Methods: All patients with ICC who underwent surgical exploration between 2008 and June 2018 were included in a database and retrospectively analysed. For statistical analyses Kaplan Meier model and log rang test were used, perioperative deaths were excluded. Results: Two hundred and ten explorations were performed with 150 resections and 60 irresectable patients. We examined the tumor relation to the liver capsule and divided in a distant (n=50), close/infiltration (n=78), perforation (n=11) and a periductal disseminating type (n=11). Overall survival (OS) was significantly influenced by the tumor proximity to the liver capsule (p=0.033) with median OS of 28 months for distant, 24.1 for close/infiltration, 20.3 for perforation and 14.5 for periductal dissemination groups. The consecutive 1-, 3-and 5-year OS was 86%, 40% and 21% for distant, 77%, 32% and 18% for close/infiltration, 76%, 23% and 0% for perforation and 58%, 0% and 0% for periductal dissemination groups, respectively. Median recurrence-free survival (RFS) 10.4 months for distant, 9.3 for close/infiltration, 16.5 for perforation and 8.1 for periductal dissemination groups. RFS did not achieve significant differences comparing the different groups (p=0.142). Consecutive 1-, 3-and 5-year RFS was 43%, 25% and 20% for distant, 35%, 13% and 11% for close/infiltration, 65%, 13% and 0% for perforation and 26%, 0% and 0% for periductal dissemination groups, respectively. Conclusion: Tumor proximity had significant influence on overall survival for ICC with a benefit for the distant > close/infiltration > perforation > periductal dissemination groups. The same could be demonstrated for recurrencefree survival without reaching statistical significance.Caption 1: Overall survival (A) and recurrence-free survival (B) dependent on tumor proximity to the liver capsule.
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