Impact of pancreatic head tumor size on the outcome of surgical management

Abstract

Background and objectives Tumor size has been identified as a critical prognostic factor after pancreatic adenocarcinoma resection; however, this is still up for debate. The authors aimed to investigate the relationship between size and the results of pancreatic cancer resection. Patients and methods The studied subjects were divided into two groups as follows: group A: included 69 patients with pancreatic head/uncinate process tumor ≤3 cm in size (maximum tumor diameter), subjected to elective pancreaticoduodenectomy, group B: included 87 patients with pancreatic head/uncinate process tumor >3 cm in size (maximum tumor diameter), subjected to elective pancreaticoduodenectomy. From January 1, 2016 to December 31, 2021, at Menoufia University’s National Liver Institute, we looked at the clinical, radiological, histological, and survival characteristics of tiny pancreatic cancer tumors (tumors ≤3 cm) in comparison to tumors above 3 cm in size following pancreaticoduodenectomy. Calculations were made of overall cancer-specific survivals. Key factors were assessed for relevance in survival prediction using a Cox proportional hazards model. Results Among the tumors measured, 44.2% were ≤3 cm in size 55.8% tumor were greater than 3 cm in size. Larger tumors were associated with worse symptoms, higher Ca19.9, more progressive TNM stages, longer operative time, more blood transfusion, higher grade, more vascular invasion, more involved surgical margin, and more lymph node invasion. Our study compared data of 1-year survival rates of 79.1% and 50% as seen with ≤3 cm tumor size and with above 3 cm tumor size, respectively, also 2-year survival rates of 40.3% and 19.2% were seen with ≤3 cm tumor size and with above 3 cm tumor size, respectively, the result being statistically significant (P<0.001). Pancreatic ductal adenocarcinoma size above 3 cm was associated with a worse prognosis together with histologic grading, vascular invasion, involved surgical margin, longer waiting list time, and progressive T stages. Conclusions Our findings suggest that early pancreatic ductal adenocarcinoma detection can have clinical benefits, which has positive implications for future screening strategies. Pancreatic ductal adenocarcinoma size above 3 cm is an independent predictive factor for poor prognosis after surgical resection and is associated with more aggressive tumor biology. Future trials are required to evaluate the survival benefit of neoadjuvant therapy in this subset of patients.