A novel role of the tumor size in pancreatic cancer as an ancillary factor for predicting resectability.
BACKGROUND
Pancreatic adenocarcinoma (PCA) is a devastating disease. Only surgery can provide effective treatment. The resectability of pancreatic cancer is mainly determined by image studies. However, half of the patients deemed as operable, radiologically, are found to be inoperable during surgery. Previously, we have showed that both CA 19-9 and tumor size could predict PCA resectability, independently. Here, we aimed to determine the cut-off value for tumor size permitting PCA resectability by receiver operating characteristic (ROC) curve analysis.


METHODS
We retrospectively reviewed 372 patients undergoing surgery for histopathologically proven PCA. We compared tumor sizes of patients in resectable and unresectable groups and analyzed them by the ROC curve.


RESULTS
The tumor size in unresectable groups is significantly larger than that in the resectable group. The area under the ROC curve was 0.73 (95% confidence interval [CI], 0.665-0.789), which represented a good correlation between the tumor size and pancreatic cancer resectability. The PCA patients with a tumor diameter of > 4.8 cm had a 5.043-fold higher chance of unresectability than did those with a tumor diameter < 4.8 cm (odds ratio, 5.043; 95% CI, 3.221-7.894).


CONCLUSIONS
A tumor diameter > 4.8 cm is a potential ancillary parameter for determining the resectability of PCA in addition to traditional image studies. Diagnosis laparoscopy may be indicated for radiologically resectable PCA patients with tumor size > 4.8 cm to prevent unnecessary laparotomy.
Kun-Chun
KC
Chiang
Chun-Hui
CH
Lee
Department of General Surgery, Chang Gung Memorial Hospital, 5, Fu-Hsing Street, Kwei-Shan, Taoyuan, Taiwan 333, R.O.C, Taiwan.
Chun-Nan
CN
Yeh
Shir-Hwa
SH
Ueng
Jun-Te
JT
Hsu
Ta-Sen
TS
Yeh
Yi-Yin
YY
Jan
Tsann-Long
TL
Hwang
Miin-Fu
MF
Chen
D000230:Adenocarcinoma / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D000368:Aged; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology* / Q000601:surgery*; D011183:Postoperative Complications; D012372:ROC Curve; D012189:Retrospective Studies; D047368:Tumor Burden