title: Preoperative high level of D-dimers predicts unresectability of pancreatic head cancer.
abstract: OBJECTIVE
  To assess the value of D-dimer level in determining resectability of pancreatic cancer.
  
  
  METHODS
  Preoperative prediction of pancreatic head cancer resectability remains inaccurate. The use of hemostatic factors may be of potential help, since D-dimers correlate with tumor stage. Single center clinical trial study comprised patients with potentially resectable pancreatic head tumor and without detectable venous thrombosis (n = 64). Resectability was defined as no evidence of nodal involvement, distant spread and no invasion of mesenteric vessels. Final decision of resectability was confirmed intraoperatively. Experienced pancreatic surgeon performed all surgeries. Following the dissection of hepatoduodenal ligament, samples of portal blood and bile were taken. Peripheral blood via central line and urine via Foley catheter were sampled. D-dimer levels were further measured.
  
  
  RESULTS
  At laparotomy only 29 (45.3%) tumors were found to be resectable. Our analysis showed higher by 57.5% (P < 0.001) mean D-dimer values in peripheral and 43.7% (P = 0.035) in portal blood of patients with unresectable pancreatic cancer. Significant differences were not observed when analyzing D-dimer levels in bile and urine. Peripheral D-dimer level correlated with pancreatic cancer resectability. When cut-off D-dimer value of 570.6 μg/L was used, the sensitivity for assessment of tumor unresectability was 82.8%. Furthermore, D-dimer level in peripheral blood of metastatic disease (n = 15) was significantly higher when compared to locally advanced (n = 20) pancreatic cancer (2470 vs 1168, P = 0.029). The area under ROC curve for this subgroup of patients was 0.87; for determination of unresectable disease when threshold of 769.8 μg/L was used, sensitivity and specificity was 86.6% and 80%, respectively.
  
  
  CONCLUSIONS
  Patients with resectable pancreatic head cancer based on preoperative imaging studies and high D-dimer level may be considered unresectable due to occult hepatic metastases. These patients may benefit from diagnostic laparoscopy to avoid exploratory laparotomy.
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Adam
authors.initials: A
authors.lastname: Durczynski
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Anna
authors.initials: A
authors.lastname: Kumor
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Hogendorf
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Dariusz
authors.initials: D
authors.lastname: Szymanski
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Piotr
authors.initials: P
authors.lastname: Grzelak
authors.affiliation: Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland.
authors.forename: Janusz
authors.initials: J
authors.lastname: Strzelczyk
mesh_terms: D000230:Adenocarcinoma / Q000097:blood* / Q000556:secondary / Q000601:surgery*; D019540:Area Under Curve; D014408:Biomarkers, Tumor / Q000097:blood*; D000075202:Contraindications; D005338:Fibrin Fibrinogen Degradation Products / Q000032:analysis*; D006801:Humans; D008113:Liver Neoplasms / Q000097:blood / Q000556:secondary; D009367:Neoplasm Staging; D010190:Pancreatic Neoplasms / Q000097:blood* / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D018579:Patient Selection; D011237:Predictive Value of Tests; D012372:ROC Curve; D012307:Risk Factors; D036542:Tomography, Spiral Computed; D018608:Ultrasonography, Doppler; D015854:Up-Regulation
chemical_list: D014408:Biomarkers, Tumor; D005338:Fibrin Fibrinogen Degradation Products; C036309:fibrin fragment D
keywords: Bile; D-dimers; Pancreatic cancer; Pancreatic cancer respectability; Peripheral blood; Portal blood; Urine