HPB P39 Do indeterminate pulmonary nodules in patients undergoing resection for pancreas cancer influence pulmonary metastasis and survival outcomes?

Abstract

Background The significance of indeterminate pulmonary nodules (IPNs) on preoperative imaging in the surgical resection of pancreatic cancers remains a clinical dilemma. IPNs are defined as ≥ 1 well-defined, non-calcified lung nodules that are ≤ 1cm in diameter. We report the prevalence and impact of IPNs in surgically managed pancreatic cancer patients from our centre. Methods We studied patients who had attempted/successful surgical resection of pancreatic cancers between 2014 and 2020. The summary statistics are presented as frequencies and percentages, while Fisher's exact test was used to calculate p value for the compared variables including the presence of IPNs, pulmonary metastasis and death. P value of <0.05 was considered statistically significant. Results Our study included 262 patients – 204 (77.9%) had surgical resections including pancreaticoduodenectomy (with or without portal venous resection) or total or distal pancreatectomy, while 58 (22.1%) had trial dissection, bypass and/or laparoscopy. All patients had a preoperative chest computed tomography (CT) scan. 25/262 (9.5%) had IPN on preoperative CT scans. 15/25 (60%) had solitary IPN, 2/25 (8%) had two IPNs, 3/25 (12%) had three IPNs, 1/25 (4%) had 6 IPNs and 4/25 (16%) reported multiple/plural IPNs. In patients with more than 1 IPN, only one patient had unilateral pulmonary nodules. 23/262 (8.8%) developed pulmonary metastasis. Of these, none had IPN preoperatively. There was no statistically significant association between IPN and pulmonary metastasis (p = 0.1428). Neoadjuvant chemotherapy was given to 13/262 patients. None of these patients had IPN pre-operatively, but 4 of them had recurrent/metastatic disease (3 Liver & 2 Pulmonary). IPN was found in 3 patients on post-operative imaging, all three developed metastatic disease after pancreaticoduodenectomies. As at 31st of October 2021, 177/262 patients had died. There was a statistically significant association between pulmonary metastasis and mortality (p = 0.0379). On the other hand, an association between IPN and mortality showed no statistical significance (p = 1.0). Conclusions Our study suggests that IPN is not linked to pulmonary metastasis in pancreatic cancer patients that were offered surgical resection. The presence of IPN did not impact mortality. Therefore, we conclude that IPN should not be used as a determining factor for surgical management of pancreatic cancers.