Retrospective Study
Copyright ©The Author(s) 2016. Published by Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Jul 14, 2016; 22(26): 6076-6082
Published online Jul 14, 2016. doi: 10.3748/wjg.v22.i26.6076
Preoperative defining system for pancreatic head cancer considering surgical resection
Seok Jeong Yang, Ho Kyoung Hwang, Chang Moo Kang, Woo Jung Lee
Seok Jeong Yang, Department of Surgery, Ulsan University Hospital, University of Ulsan College of Medicine, Ulsan 44033, South Korea
Ho Kyoung Hwang, Chang Moo Kang, Woo Jung Lee, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, Seoul 120-752, South Korea
Ho Kyoung Hwang, Chang Moo Kang, Woo Jung Lee, Pancreaticobiliary Cancer Clinic, Yonsei Cancer Center, Institute of Gastroenterology, Yonsei Severance Hospital, Seoul 120-752, South Korea
Author contributions: Yang SJ, Hwang HK, Kang CM and Lee WJ contributed equally to this work; Yang SJ collected and analyzed the data, and drafted the manuscript; Hwang HK provided analytical oversight; Kang CM designed and supervised the study; Lee WJ revised the manuscript for important intellectual content and provided administrative support; all authors have read and approved the final version to be published
Institutional review board statement: This study was approved by the Institutional Review Board of the Yonsei University School of Medicine.
Conflict-of-interest statement: The authors declare no potential conflict of interest.
Data sharing statement: No additional data are available.
Open-Access: This article is an open-access article which was selected by an in-house editor and fully peer-reviewed by external reviewers. It is distributed in accordance with the Creative Commons Attribution Non Commercial (CC BY-NC 4.0) license, which permits others to distribute, remix, adapt, build upon this work non-commercially, and license their derivative works on different terms, provided the original work is properly cited and the use is non-commercial. See: http://creativecommons.org/licenses/by-nc/4.0/
Correspondence to: Chang Moo Kang, MD, PhD, Department of Hepatobiliary and Pancreatic Surgery, Yonsei University College of Medicine, 50 Yonsei-ro, Seodaemun-gu, Seoul 120-752, South Korea. cmkang@yuhs.ac
Telephone: +82-2-22282122 Fax: +82-2-3138289
Received: December 1, 2015
Peer-review started: December 4, 2015
First decision: January 13, 2016
Revised: January 27, 2016
Accepted: February 20, 2016
Article in press: February 22, 2016
Published online: July 14, 2016
Abstract

AIM: To provide appropriate treatment, it is crucial to share the clinical status of pancreas head cancer among multidisciplinary treatment members.

METHODS: A retrospective analysis of the medical records of 113 patients who underwent surgery for pancreas head cancer from January 2008 to December 2012 was performed. We developed preoperative defining system of pancreatic head cancer by describing “resectability - tumor location - vascular relationship - adjacent organ involvement - preoperative CA19-9 (initial bilirubin level) - vascular anomaly”. The oncologic correlations with this reporting system were evaluated.

RESULTS: Among 113 patients, there were 75 patients (66.4%) with resectable, 34 patients (30.1%) with borderline resectable, and 4 patients (3.5%) with locally advanced pancreatic cancer. Mean disease-free survival was 24.8 mo (95%CI: 19.6-30.1) with a 5-year disease-free survival rate of 13.5%. Pretreatment tumor size ≥ 2.4 cm [Exp(B) = 3.608, 95%CI: 1.512-8.609, P = 0.044] and radiologic vascular invasion [Exp(B) = 5.553, 95%CI: 2.269-14.589, P = 0.002] were independent predictive factors for neoadjuvant treatment. Borderline resectability [Exp(B) = 0.222, P = 0.008], pancreatic head cancer involving the pancreatic neck [Exp(B) = 9.461, P = 0.001] and arterial invasion [Exp(B) = 6.208, P = 0.010], and adjusted CA19-9 ≥ 50 [Exp(B) = 1.972 P = 0.019] were identified as prognostic clinical factors to predict tumor recurrence.

CONCLUSION: The suggested preoperative defining system can help with designing treatment plans and also predict oncologic outcomes.

Keywords: Preoperative defining system, Pancreas head cancer, Borderline resectable, Adjusted CA19-9, Neoadjuvant therapy

Core tip: Owing to the anatomical complexity of the pancreas head cancer, it is not always easy to share the exact disease status among multidisciplinary treatment members. So, we made a preoperative defining system, which contained the important clinical variables (resectability, tumor location, vascular relationship, adjacent organ involvement, preoperative CA19-9, vascular anomaly) to decide the treatment plan for pancreas head cancer. Through internal validation, we proved that this system could be useful not only to clarify the disease characteristics but also to predict oncologic outcomes of pancreas head cancer.