Abstract
Purpose
This study aimed to clarify the key factors for minimizing unsuitable surgical interventions for patients with radiologically occult metastatic pancreatic cancer (ROMPC), defined as a distant metastasis detected during surgery or within 6 months after resection.
Methods
This study involved 502 patients planned to undergo curative resection for pancreatic cancer between 2008 and 2015. Patients were divided into ROMPC and non-ROMPC groups and evaluated preoperative factors associated with ROMPC.
Results
Overall survival (OS) was significantly lower in the ROMPC group (n = 145) than the non-ROMPC group (n = 357, median survival time [MST] 10.8 vs. 35.3 months, P < 0.001). In the ROMPC group, OS tended to be worse for patients who had pancreatectomies (n = 84) than those who did not (n = 61, MST 10.1 vs. 13.2 months, P = 0.057), and the next chemotherapy started significantly later in patients who had pancreatectomies (P < 0.001). Moreover, OS was significantly lower for patients with (n = 82) than without (n = 63) liver metastases (MST 9.7 vs. 13.0 months, respectively, P = 0.020). The best indicator for patients at higher risk of ROMPC was a combination of carbohydrate antigen 19-9 concentration ≥ 300 U/ml and tumor size ≥ 30 mm.
Conclusions
In the ROMPC group, patients who underwent pancreatectomy had a poorer prognosis than patients not undergoing pancreatectomy. Given that the liver was the most frequent distant metastatic site for ROMPC and had the poorest prognosis, establishing a strategy featuring new imaging modalities to detect radiologically occult liver metastases is necessary.
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Study conception and design: Oba, Inoue, Mise, Takahashi, Saiura. Acquisition of data: Oba, Irie, Sato, Ono, Inoue. Analysis and interpretation of data: Oba, Inoue, Saiura. Drafting of manuscript: Oba, Inoue, Ito. Critical revision: Inoue, Takahashi, Saiura. Final approval: Oba, Inoue, Ono, Irie, Sato, Mise, Ito, Takahashi, Saiura.
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All procedures performed in studies involving human participants were in accordance with the ethical standards of the institutional and/or national research committee and with the 1964 Helsinki Declaration and its later amendments or comparable ethical standards.
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The present retrospective study was approved by the Institutional Review Board of the Cancer Institute Hospital of the Japanese Foundation for Cancer Research, with a waiver of the written informed consent from all patients concerned.
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Oba, A., Inoue, Y., Ono, Y. et al. Radiologically occult metastatic pancreatic cancer: how can we avoid unbeneficial resection?. Langenbecks Arch Surg 405, 35–41 (2020). https://doi.org/10.1007/s00423-019-01846-2
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DOI: https://doi.org/10.1007/s00423-019-01846-2