Impact of Preoperative Tumor Size on Prognosis of Resectable and Borderline Resectable Pancreatic Ductal Adenocarcinomas

• Published in: Annals of surgical oncology 2023-12, Vol.30 (13), p.8621-8630
• Main Authors: Miyata, Yoichi, Yonamine, Naoto, Fujinuma, Ibuki, Tsunenari, Takazumi, Takihata, Yasuhiro, Hakoda, Hiroyuki, Nakazawa, Akiko, Iwasaki, Toshimitsu, Einama, Takahiro, Togashi, Junichi, Tsujimoto, Hironori, Ueno, Hideki, Beck, Yoshifumi, Kishi, Yoji
• Format: Article
• Language: English
• Subjects: Adenocarcinoma; Carcinoma, Pancreatic Ductal - surgery; Humans; Medical prognosis; Medicine; Medicine & Public Health; Multivariate analysis; Oncology; Pancreas; Pancreatectomy - adverse effects; Pancreatic cancer; Pancreatic Neoplasms; Pancreatic Neoplasms - surgery; Pancreatic Tumors; Prognosis; Retrospective Studies; Surgery; Surgical Oncology; Survival; Tumors
• ISSN: 1068-9265; 1534-4681
• DOI: 10.1245/s10434-023-14219-3

Background Tumor size (TS) is a well-established prognostic factor of pancreatic ductal adenocarcinoma (PDAC). However, whether a uniform treatment strategy can be applied for all resectable PDACs (R-PDACs) and borderline resectable PDACs (BR-PDACs), regardless of TS, remains unclear. This study aimed to investigate the impact of preoperative TS on surgical outcomes of patients with R-PDACs and BR-PDACs. Methods Chart data from three institutions were reviewed to select patients who underwent pancreatectomy for R-PDACs and BR-PDACs between January 2006 and December 2020. The patients were divided into TS small and TS large groups according to a TS cutoff value determined for each of R- and BR-PDAC using the minimum P value approach for the risk of R1 resection. Results TS of 35 mm and 24 mm was the best cutoff value in R-PDAC and BR-PDAC, respectively. The R1 rate was higher in the TS large than TS small group, in both R- ( n = 35, 37% versus n = 294, 19%; P = 0.011) and BR-PDAC ( n = 89, 37% versus n = 27, 15%; P = 0.030). Overall survival was significantly better in the TS small than TS large group in R-PDAC (38.2 versus 12.1 months; P < 0.001), but comparable between the two groups in BR-DPAC (21.2 versus 22.7 months; P = 0.363). Multivariate analysis revealed TS > 35 mm as an independent predictor of worse survival in patients with R-PDAC. Conclusion Larger TS was associated with a higher R1 rate and is a worse prognostic factor in patients with R-PDAC.