Is a Preoperative Assessment of the Early Recurrence of Pancreatic Cancer Possible after Complete Surgical Resection?

Abstract

Background/AimsThe prognosis of pancreatic adenocarcinoma (PAC) is poor. The serum carbohydrate antigen 19-9 (CA 19-9) level has been identified as a prognostic indicator of recurrence and reduced overall survival. The aim of this study was to identify preoperative prognostic factors and to create a prognostic model able to assess the early recurrence risk for patients with resectable PAC.MethodsA series of 177 patients with PAC treated surgically at the St. Andrea Hospital of Rome between January 2003 and December 2011 were reviewed retrospectively. Univariate and multivariate analyses were utilized to identify preoperative prognostic indicators.ResultsA preoperative CA 19-9 level >228 U/mL, tumor size >3.1 cm, and the presence of pathological preoperative lymph nodes statistically correlated with early recurrence. Together, these three factors predicted the possibility of an early recurrence with 90.4% accuracy. The combination of these three preoperative conditions was identified as an independent parameter for early recurrence based on multivariate analysis (p=0.0314; hazard ratio, 3.9811; 95% confidence interval, 1.1745 to 15.3245).ConclusionsPAC patient candidates for surgical resection should undergo an assessment of early recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice.

Preoperative predictors for early recurrence of resectable pancreatic cancer

“…Only 20% of patients with pancreatic cancer are candidates for potentially radical resection [2]. Surgical resection is associated with a median OS of 11 to 23 months and with a 5-year OS of about 20% [3, 4]. Furthermore, 60% of patients experience local and systemic relapse within the first 12 months after curative surgery [3].…”

“…Surgical resection is associated with a median OS of 11 to 23 months and with a 5-year OS of about 20% [3, 4]. Furthermore, 60% of patients experience local and systemic relapse within the first 12 months after curative surgery [3]. Preoperative predictors of survival time after surgery have been reported as tumor size [3], preoperative lymph node metastasis [3], preoperative serum carbohydrate antigen (CA19-9) level [2, 3, 5], G3–G4 on pathological grading [2], duration of symptoms [2], and preoperative modified Glasgow Prognostic Score (mGPS) [6].…”

“…In fact, occult peritoneal or liver metastatic disease has been reported to be missed by CT in 4 to 15% of patients [3]. …”

Reconsideration about the aggressive surgery for resectable pancreatic cancer: a focus on real pathological portosplenomesenteric venous invasion

“…Pancreatic cancer patient who are candidates for surgical resection should undergo an assessment of early-recurrence risk to avoid unnecessary and ineffective resection and to identify patients for whom palliative or alternative treatment may be the treatment of choice, even if surgeons may consider that pancreatic cancer could be completely removed based on the preoperative imaging [23]. From a clinical perspective, the poor outcome of patients with actual venous invasion is very important, and in our series, patients with PV invasion apparently had worse prognosis than those without invasion.…”

Endoscopic ultrasound guided gastroenterostomy for efferent jeunal loop obstruction in a patient with previous pancreaticoduodenectomy and ascites

“…Patient died 2 months later, due to disease's progression, without evidence of GOO symptoms recurrence. After curative surgery for pancreatic cancer up to 60 % of patients develop local and systemic recurrence within the first 12 months [1]. In some cases, recurrence at gastro-jejunal anastomosis or peritoneal carcinomatosis determines GOO.…”