Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer
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.
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.
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.
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
KeywordsPancreatic cancer Early detection Screening Surgical outcomes
CAPS 3 study participating centers and co-investigators (listed in alphabetical order) Dana Farber Cancer Institute, Boston, MA (Koenraad Mortele, John Saltzman, Sapna Syngal); The Mayo Clinic, Rochester, MN (Joel Fletcher, Gloria Petersen, Naoki Takahashi, Mark Topazian), MD Anderson Cancer Center, Houston, TX (Priya Bosale, Jeffrey Lee, Eric Tamm, Raghunandan Vikram), and University of California, Los Angeles, CA (James Farrell, Daniel Margolis).
Conceived and designed the study: Marcia Canto and Michael Goggins.
Acquisition of data: Tossapol Kerdsirichairat, Madeline Ford, Ammar Javed, Marcia Canto, Anne Marie Lennon, Eun Ji Shin, Elliott Fishman, Ihab Kamel, Jin He, Richard Burkhart, Martin Makary, Richard Schulick, Charles Yeo, Matthew Weiss and Christopher Wolfgang.
Analysis and interpretation of data: Tossapol Kerdsirichairat, Amanda Blackford, Alison Klein, Marcia Canto, Michael Goggins, Ralph Hruban.
Drafted the manuscript: Tossapol Kerdsirichairat and Marcia Canto.
Statistical analysis: Tossapol Kerdsirichairat, Marcia Canto, Amanda Blackford.
Revised the manuscript and agreed with the manuscript’s results and conclusions: all authors.
Study support: Marcia Canto and Michael Goggins.
Obtained funding: Marcia Canto, Ralph Hruban, and Michael Goggins.
Study supervision: Marcia Canto, Michael Goggins.
This work was supported by the National Institutes of Health grants (CA210170, CA176828, CA62924, CA154823, CA132829), Susan Wojcicki and Dennis Troper, the Pancreatic Cancer Action Network, the Lustgarten Foundation for Pancreatic Cancer Research, the Rolfe Pancreatic Cancer Foundation, the John and Peter Hooven Memorial Endowment, Hugh and Rachel Victor, and ChiRhoCin, Inc.
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