title: Asymptomatic Pancreatic Cancer: Does Incidental Detection Impact Long-Term Outcomes?
abstract: Detection of pancreatic ductal adenocarcinoma (PDAC) in asymptomatic patients is very rare, and the clinical implication of early detection of asymptomatic PDAC remains unclear.
  
  
  
  This retrospective study included 569 consecutive patients with PDAC treated in our institution (250 underwent surgical resection and 319 had unresectable PDAC). The patients' demographics, tumor locations, pathologic stages, treatment, and overall survival (OS) were compared between the asymptomatic and symptomatic patients.
  
  
  
  In total, 163 (29%) patients presented without subjective symptoms. These patients had an earlier stage of PDAC on presentation (p < 0.001), higher resectability rate (64 vs. 36%, p < 0.001), and higher 5-year OS rate (18 vs. 7%, p < 0.001) than patients with symptoms. Among the patients who underwent resection, asymptomatic patients did not have a significantly higher chance of complete resection (88 vs. 78%, p = 0.06) or 5-year OS rate (23 vs. 22%, p = 0.09). However, symptomatic patients more often required complex operations such as concomitant vascular resection and reconstruction (57 vs. 29%, p < 0.001).
  
  
  
  Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC because of the earlier stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening programs for early detection of PDAC in selected high-risk populations.
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yoshinori
authors.initials: Y
authors.lastname: Takeda
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan. akio.saiura@jfcr.or.jp.
authors.forename: Akio
authors.initials: A
authors.lastname: Saiura
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yu
authors.initials: Y
authors.lastname: Takahashi
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yosuke
authors.initials: Y
authors.lastname: Inoue
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Takeaki
authors.initials: T
authors.lastname: Ishizawa
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Yoshihiro
authors.initials: Y
authors.lastname: Mise
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Masaru
authors.initials: M
authors.lastname: Matsumura
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Hirofumi
authors.initials: H
authors.lastname: Ichida
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Ryota
authors.initials: R
authors.lastname: Matsuki
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Masayuki
authors.initials: M
authors.lastname: Tanaka
authors.affiliation: Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan.
authors.forename: Hiromichi
authors.initials: H
authors.lastname: Ito
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D058070:Asymptomatic Diseases; D021441:Carcinoma, Pancreatic Ductal / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D055088:Early Detection of Cancer; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D033162:Incidental Findings; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000175:diagnosis* / Q000401:mortality / Q000601:surgery; D012189:Retrospective Studies; D015996:Survival Rate; D016896:Treatment Outcome
keywords: Asymptomatic pancreatic cancer; Resection rate; Screening; Survival