Very high serum CA 19-9 levels: a contraindication to pancreaticoduodenectomy?
OBJECTIVE
To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels.


METHODS
From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels >or=900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.


RESULTS
Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.


CONCLUSIONS
Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.
Turrini
O
O
Department of Surgery, Indiana University School of Medicine, Indianapolis, IN, USA.
Schmidt
C M
CM
Moreno
J
J
Parikh
P
P
Matos
J M
JM
House
M G
MG
Zyromski
N J
NJ
Nakeeb
A
A
Pitt
H A
HA
Lillemoe
K D
KD
D000230:Adenocarcinoma / Q000097:blood / Q000601:surgery*; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000097:blood*; D018395:CA-19-9 Antigen / Q000097:blood*; D000075202:Contraindications; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000097:blood / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011184:Postoperative Period; D011237:Predictive Value of Tests; D057234:Preoperative Period; D011379:Prognosis; D016019:Survival Analysis; D016896:Treatment Outcome
D014408:Biomarkers, Tumor; D018395:CA-19-9 Antigen