Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer

• Published in: Journal of gastrointestinal surgery 2020-05, Vol.24 (5), p.1101-1110
• Main Authors: Canto, Marcia Irene, Kerdsirichairat, Tossapol, Yeo, Charles J., Hruban, Ralph H., Shin, Eun Ji, Almario, Jose Alejandro, Blackford, Amanda, Ford, Madeline, Klein, Alison P., Javed, Ammar A., Lennon, Anne Marie, Zaheer, Atif, Kamel, Ihab R., Fishman, Elliot K., Burkhart, Richard, He, Jin, Makary, Martin, Weiss, Matthew J., Schulick, Richard D., Goggins, Michael G., Wolfgang, Christopher L.
• Format: Article
• Language: English
• Subjects: Carcinoma, Pancreatic Ductal - diagnosis; Carcinoma, Pancreatic Ductal - surgery; Diabetes; Early Detection of Cancer; Gastroenterology; Humans; Medicine; Medicine & Public Health; Mortality; Original Article; Pancreatectomy - adverse effects; Pancreatic cancer; Pancreatic Neoplasms - diagnosis; Pancreatic Neoplasms - surgery; Retrospective Studies; Surgery; Treatment Outcome; Tumors
• ISSN: 1091-255X; 1873-4626
• DOI: 10.1007/s11605-019-04230-z

Background Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. Methods Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. Results Among 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. Conclusions Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration Number NCT2000089