Risk factors and outcomes for patients with pancreatic cancer undergoing surgical exploration without resection due to metastatic disease: A national cohort study |
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| Affiliation: | 1. Department of Clinical Sciences Lund, Surgery, Lund University, Sweden;2. Department of Surgery, Central Hospital Kristianstad, Sweden;3. Department of Translational Medicine, Cardiothoracic surgery and bioinformatics, Lund University, Sweden;4. Department of Thoracic and vascular surgery, Skåne University hospital, Lund, Sweden;5. Department of Surgery, Skåne University Hospital, Lund, Sweden;1. Department of Gastroenterology, Santa Luzia Hospital - Unidade Local de Saúde Alto Minho, Viana do Castelo, Portugal;2. Department of Gastroenterology, Professor Doutor Fernando Fonseca Hospital, Amadora, Portugal;3. Department of Gastroenterology, Nova Medical School/Faculty of Medical Sciences, Lisbon, Portugal;4. University Center of Gastrenterology - Hospital Cuf Tejo, Lisbon, Portugal;5. Life and Health Sciences Research Institute (ICVS), School of Medicine, University of Minho, Braga, Portugal;6. ICVS/3B''s - PT Government Associate Laboratory, Braga/Guimarães, Portugal;1. Pathology Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì, Italy;2. General and Oncologic Surgery Unit, Morgagni-Pierantoni Hospital, AUSL Romagna, Via Carlo Forlanini 34, 47121, Forlì, Italy;3. Department of Medical and Surgical Sciences, Alma Mater Studiorum, University of Bologna, Via Massarenti 9, 40138, Bologna, Italy;1. Division of Gastroenterology and Digestive Endoscopy, Humanitas Research Hospital - IRCCS, Milan, Italy;2. Department of Biomedical Sciences, Humanitas University, Milan, Italy |
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| Abstract: | BackgroundUnresectable disease is sometimes diagnosed during surgery in patients with pancreatic ductal adenocarcinoma (PDAC). This study aimed to identify preoperative risk factors for metastatic disease diagnosed at surgical exploration and to investigate and compare survival in resected and non-resected patients.MethodsPatients were identified from the Swedish National Pancreatic and Periampullary Cancer Registry 2010-2018. Predictors of metastatic disease were evaluated with a multivariable logistic regression model, and survival was evaluated with Kaplan-Meier estimates and log-rank tests.ResultsIn total, 1938 patients with PDAC were scheduled for surgery. An unresectable situation was diagnosed intraoperatively in 399 patients (20.6%), including 234 (12.1%) with metastasized disease. Independent risk factors for metastasis were involuntary weight loss (OR = 1.72; 95% CI: 1.27-2.33) and elevated carbohydrate antigen 19-9 (CA19-9) (35-599 U/mL, OR = 1.79, 95% CI: 1.11-2.89; ≥ 600 U/mL, OR = 3.24, 95% CI: 2.04-5.17). Overall survival was lower among patients with metastasized disease than that among patients with a resectable tumor (P < 0.001).ConclusionsInvoluntary weight loss and an elevation of CA19-9 are preoperative risk factors for diagnosing metastasized disease during surgical exploration. |
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