Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Lee, Jun Young; An, Chansik; Hwang, Ho Kyoung; Roh, Yun Ho; Kang, Hyun Seung; Jo, Jung Hyun; Chung, Moon Jae; Park, Jeong Youp; Kang, Chang Moo; Park, Seung Woo; Yoon, Dong Sup; Lee, Woo Jung; Song, Si Young; Bang, Seungmin

doi:10.1111/jgh.14837

Cited by 10 publications

(10 citation statements)

References 26 publications

(46 reference statements)

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“…A couple of factors have been reported to be associated with occult metastatic disease, including younger age, male sex, weight loss, larger tumor size, higher CA19-9, suspicious lymph node and more extensive peripancreatic tumor infiltration et al (4,6,9,26). Our study showed that ALT >40 U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis.…”

Section: Discussionsupporting

confidence: 59%

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

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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Background: Surgical resection is the only potentially curative treatment for pancreatic ductal adenocarcinoma (PDAC). However, most of patients lose the chance of surgery due to the unresectable disease at the time of diagnosis. Despite the improvement of radiological imaging, a portion of patients intended for radical resection were proven to be unresectable at surgical exploration due to occult metastasis.Methods: Patients who were aimed to undergo radical pancreatectomy for PDAC from 2010 to 2019 were reviewed retrospectively. All patients included underwent diagnostic laparoscopic exploration. Patients were divided into two groups depending on whether distant metastasis were encountered during exploration.Univariate and multivariate logistic regression analyses were used to identify risk factors for occult metastasis.A nomogram to predict occult metastasis of PDAC on exploration was developed and evaluated.Results: A total of 273 patients who underwent diagnostic laparoscopic exploration were included in this study. Nineteen (7.0%) patients were found with distant metastasis during exploration. Multivariate logistic regression analysis showed that ALT>40U/L, CA19-9, CA125 and regional nodes enlargement were independent predictors for occult metastasis. Incorporating these four factors, the nomogram achieved concordance index of 0.799, with a well-fitted calibration curve.Conclusions: Occult metastasis is not unusual during surgical exploration in patients with resectable or borderline resectable PDAC. The nomogram could achieve a personal prediction of unexpected distant metastasis on exploration. It may help to sift through patients with PDAC who would benefit from laparoscopic exploration.

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Section: Discussionsupporting

confidence: 59%

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

Ge¹,

Li²,

Ma³

et al. 2021

Gland Surg

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“…Few studies have reproduced the insignificant prognostic value of extrapancreatic extension, 7 whereas several studies have demonstrated otherwise. 3,8,9 The greatest advantages of removing extrapancreatic extension and categorizing based on size alone are preventing the majority of tumors from being categorized as T3 and increasing the reproducibility of staging. [12][13][14] However, although limited to T1 pancreatic cancer, this study has demonstrated the prognostic relevance of extrapancreatic extension through survival analysis and multivariate analysis.…”

Section: Discussionmentioning

confidence: 99%

“…However, the details of relevant results were not presented in the article. Furthermore, a limited number of studies were able to reproduce the prognostic insignificance of extrapancreatic extension, 7 whereas other studies have reported contrary results 3,8,9 . Therefore, the feasibility of this change needs to be re‐examined using a reliable dataset of T1 pancreatic cancer cases.…”

Section: Introductionmentioning

confidence: 99%

Features of T1 pancreatic cancer and validation of the eighth edition AJCC staging system definition using a Korean–Japanese joint cohort and the SEER database

Kwon

Heo

Han

et al. 2023

J Hepato Biliary Pancreat

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Background/PurposeLittle is known about the features of T1 pancreatic ductal adenocarcinoma (PDAC) and its definition in the eighth edition of the American Joint Committee on Cancer (AJCC) staging system needs validation. The aims were to analyze the clinicopathologic features of T1 PDAC and investigate the validity of its definition.MethodData from 1506 patients with confirmed T1 PDAC between 2000 and 2019 were collected and analyzed. The results were validated using 3092 T1 PDAC patients from the Surveillance, Epidemiology, and End Results (SEER) database.ResultsThe median survival duration of patients was 50 months, and the 5‐year survival rate was 45.1%. R0 resection was unachievable in 10.0% of patients, the nodal metastasis rate was 40.0%, and recurrence occurred in 55.2%. The current T1 subcategorization was not feasible for PDAC, tumors with extrapancreatic extension (72.8%) had worse outcomes than those without extrapancreatic extension (median survival 107 vs. 39 months, p < .001). Extrapancreatic extension was an independent prognostic factor whereas the current T1 subcategorization was not. The results of this study were reproducible with data from the SEER database.ConclusionDespite its small size, T1 PDAC displayed aggressive behavior warranting active local and systemic treatment. The subcategorization by the eighth edition of the AJCC staging system was not adequate for PDAC, and better subcategorization methods need to be explored. In addition, the role of extrapancreatic extension in the staging system should be reconsidered.

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“…Second, the aggressive nature of surgery for PDAC, which is pylorus-preserving pancreaticoduodenectomy, prevents patients from receiving adjuvant chemotherapy with surgery-related morbidity and complications. 6,7 According to previous studies, only 26% to 74% of patients receive postoperative therapy because of postoperative complications, reduced performance status, and early disease recurrence. [8][9][10][11] Neoadjuvant therapy for PDAC has been considered an alternative option in borderline resectable/locally advanced PDAC.…”

Section: Introductionmentioning

confidence: 99%

Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis

et al. 2022

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Lee contributed equally to this work as first authors.Background/Aims: Controversy regarding the effectiveness of neoadjuvant therapy for resectable pancreatic ductal adenocarcinoma (PDAC) still exists. Here, we aimed to identify the potential benefits of neoadjuvant therapy followed by surgery for resectable PDAC. Methods:We reviewed radiologically resectable PDAC patients who received resection with curative intent at a tertiary hospital in South Korea between January 2012 and August 2019. A total of 202 patients underwent curative resection for resectable PDAC: 167 underwent surgical resection first during this period, and 35 received neoadjuvant chemotherapy/chemoradiation therapy followed by surgery. Resectable PDAC patients were subdivided, and 1:3 propensity score matching (PSM) was performed to reduce selection bias.Results: Compared with the group that received surgery first, the group that received neoadjuvant treatment followed by surgery had significantly smaller tumors (22.0 mm vs 27.0 mm, p=0.004), a smaller proportion of patients with postoperative pathologic T stage (p=0.026), a smaller proportion of patients with lymphovascular invasion (20.0% vs 40.7%, p=0.022), and a larger proportion of patients with negative resection margins (74.3% vs 51.5%, p=0.049). After PSM, the group that received neoadjuvant therapy had a significantly longer progression-free survival than those in the group that underwent surgery first (29.6 months vs 15.1 months, p=0.002). Overall survival was not significantly different between the two groups after PSM analysis. Conclusions:We observed significantly better surgical outcomes and progression-free survival with the addition of neoadjuvant therapy to the management of resectable PDAC. However, despite PSM, there was still selection bias due to the use of different regimens between the groups receiving surgery first and neoadjuvant therapy. Large homogeneous samples are needed in the future prospective studies.

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Preoperative prediction of futile surgery in patients with radiologically resectable or borderline resectable pancreatic adenocarcinoma

Cited by 10 publications

References 26 publications

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

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

Features of T1 pancreatic cancer and validation of the eighth edition AJCC staging system definition using a Korean–Japanese joint cohort and the SEER database

Response to Neoadjuvant Therapy and Prognosis in Patients with Resectable Pancreatic Cancer: A Propensity Score Matching Analysis

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