title: Is tumour size an underestimated feature in the current TNM system for malignancies of the pancreatic head?
abstract: BACKGROUND
  As the long-term survival of pancreatic head malignancies remains dismal, efforts have been made for a better patient selection and a tailored treatment. Tumour size could also be used for patient stratification.
  
  
  METHODS
  One hundred and fourteen patients underwent a pancreaticoduodenectomy for pancreatic adenocarcinoma, peri-ampullary and biliary cancer stratified according to: ≤20 mm, 21-34 mm, 35-45 mm and >45 mm tumour size.
  
  
  RESULTS
  Patients with tumour sizes of ≤20 mm had a N1 rate of 41% and a R1/2 rate of 7%. The median survival was 3.4 years. N1 and R1/2 rates increased to 84% and 31% for tumour sizes of 21-34 mm (P = 0.0002 for N, P = 0.02 for R). The median survival decreased to 1.6 years (P = 0.0003). A further increase in tumour size of 35-45 mm revealed a further increase of N1 and R1/2 rates of 93% (P < 0.0001) and 33%, respectively. The median survival was 1.2 years (P = 0.004). Tumour sizes >45 mm were related to a further decreased median survival of 1.1 years (P = 0.2), whereas N1 and R1/2 rates were 87% and 20%, respectively.
  
  
  CONCLUSIONS
  Tumour size is an important feature of pancreatic head malignancies. A tumour diameter of 20 mm seems to be the cut-off above which an increased rate of incomplete resections and metastatic lymph nodes must be encountered and the median survival is reduced.
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: David
authors: D
authors: Petermann
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Nicolas
authors: N
authors: Demartines
authors: Department of Visceral Surgery, University Hospital CHUV, Lausanne, Switzerland.
authors: Markus
authors: M
authors: Schäfer
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D009367:Neoplasm Staging / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000473:pathology*; D011379:Prognosis; D012189:Retrospective Studies; D012720:Severity of Illness Index; D047368:Tumor Burden