Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Abstract

Background The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. Methods We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10‐year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. Results In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non‐OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19‐9 (CA 19‐9) values ( P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non‐OMD patients ( P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19‐9 > 192 U/mL. Conclusions Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19‐9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.

Performance of Multiparametric Functional Imaging and Texture Analysis in Predicting Synchronous Metastatic Disease in Pancreatic Ductal Adenocarcinoma Patients by Hybrid PET/MR: Initial Experience

“…Regarding the tumor size and location, our results were consistent with previous studies (2,3,22,23). The larger the tumor, the more likely it is to have distant metastasis.…”

“…It often presents at a late stage, and exhibits a 5-year overall survival rate of <8% (1). Distant metastasis is still frequently encountered in the operation of patients with potentially resectable PDAC (2,3). Currently surgical resection is the only curative treatment for PADC.…”

A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration

“…However, only 10-20% of pancreatic adenocarcinoma are resectable disease at the time of diagnosis (3). And among those anatomic resectable Original Article A nomogram of preoperative predictors for occult metastasis in patients with PDAC during laparoscopic exploration or borderline resectable patients, 5% to 25% of patients are found to have occult metastatic disease at exploration (4)(5)(6). Although the technology of radiography has been improved over the past few decades, the sensitivity of detecting peritoneal disease and subcentimetric liver metastases is limited (7).…”

Histone demethylase JMJD3 disrupts spectrin-dependent cytoskeleton in Pancreatic Ductal Adenocarcinoma cells by regulating H exokinase domain containing 1 expression

“…Most PDAC patients are diagnosed with metastatic disease, and majority of patients will develop metastatic disease even after the localized lesions are resected [27,28]. Therefore, the development of more effective strategies to combat PDAC metastasis is of paramount importance.…”