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Impact of Tumor Size on the Outcomes of Patients with Resectable Distal Pancreatic Cancer: Lessons Learned from a Series of 158 Radical Resections

  • Pancreatic Tumors
  • Published:
Annals of Surgical Oncology Aims and scope Submit manuscript

Abstract

Background

Neoadjuvant therapy is used for borderline resectable pancreatic ductal adenocarcinoma (PDAC) with high risk of incomplete resection and early recurrence. Because distal PDAC is rare, the optimal criteria for neoadjuvant therapy specific for distal PDAC remain unclear. We hypothesized large distal PDAC would recur earlier than small distal PDAC.

Objective

The aim of this study was to identify the risk factors for failure of upfront resection for resectable distal PDAC.

Methods

The study cohort comprised 158 patients with resectable distal PDAC who underwent radical resection. The long-term outcomes were recurrence-free survival (RFS), disease-specific survival (DSS), and post-recurrence survival (PRS).

Results

R0 resection was achieved in 92% of patients, and median DSS for the entire cohort was 31 months. Among 103 patients who developed recurrence, 32 (31%) developed recurrence within 6 months. The median PRS and DSS for those with early recurrence was 6 and 10 months, respectively, compared with 11 and 30 months, respectively, for those with late recurrence (p = 0.017 and p < 0.001, respectively). Patients with tumors > 4 cm had higher rates of R1 resection (16%) and concomitant resection of another organ (19%) than those with smaller tumors (4% and 2%, p = 0.009 and p < 0.001, respectively). In multivariate analysis, tumor > 4 cm remained a significant predictor of early recurrence (p < 0.001, hazard ratio [HR] 6.51), shorter RFS (p = 0.018, HR 1.71), and shorter DSS (p = 0.002, HR 2.07).

Conclusion

Tumor size > 4 cm is a reliable predictor of early recurrence after resection of distal PDAC, and neoadjuvant therapy may help select patients who can benefit from radical resection.

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Acknowledgments

The authors thank Kelly Zammit, BVSc, from Edanz Group (https://en-author-services.edanz.com/ac) for editing a draft of this manuscript.

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Authors and Affiliations

  1. Division of Hepatobiliary and Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, Tokyo, Japan

    Genki Watanabe MD, Yuta Ushida MD, Atsushi Oba MD, Yoshihiro Ono MD, Takafumi Sato MD, Yosuke Inoue MD, Yu Takahashi MD, Akio Saiura MD & Hiromichi Ito MD

  2. Hepato-Biliary-Pancreatic Surgery Division, Department of Surgery, Graduate School of Medicine, The University of Tokyo, Tokyo, Japan

    Genki Watanabe MD

  3. Department of Hepatobiliary-Pancreatic Surgery, Juntendo University School of Medicine, Tokyo, Japan

    Akio Saiura MD

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  1. Genki Watanabe MD
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Correspondence to Hiromichi Ito MD.

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Genki Watanabe, Yuta Ushida, Atsushi Oba, Yoshihiro Ono, Takafumi Sato, Yosuke Inoue, Yu Takahashi, Akio Saiura, and Hiromichi Ito have no actual or potential conflicts of interest or any support funding in relation to the submission of this article.

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Watanabe, G., Ushida, Y., Oba, A. et al. Impact of Tumor Size on the Outcomes of Patients with Resectable Distal Pancreatic Cancer: Lessons Learned from a Series of 158 Radical Resections. Ann Surg Oncol 29, 378–388 (2022). https://doi.org/10.1245/s10434-021-10560-7

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