Clinical Trials Study
Copyright ©2014 Baishideng Publishing Group Inc. All rights reserved.
World J Gastroenterol. Sep 28, 2014; 20(36): 13167-13171
Published online Sep 28, 2014. doi: 10.3748/wjg.v20.i36.13167
Preoperative high level of D-dimers predicts unresectability of pancreatic head cancer
Adam Durczynski, Anna Kumor, Piotr Hogendorf, Dariusz Szymanski, Piotr Grzelak, Janusz Strzelczyk
Adam Durczynski, Piotr Hogendorf, Dariusz Szymanski, Janusz Strzelczyk, Department of General and Transplant Surgery, Medical University of Lodz, 90-153 Lodz, Poland
Anna Kumor, Department of Allergology and Pulmonary Diseases, Medical University of Lodz, 90-153 Lodz, Poland
Piotr Grzelak, Department of Radiology and Diagnostic Imaging, Medical University of Lodz, 90-153 Lodz, Poland
Author contributions: All authors contributed equally to this work.
Supported by Grant from Medical University of Lodz, No 503/8-145-01/503/01
Correspondence to: Adam Durczynski, MD, PhD, Department of General and Transplant Surgery, Medical University of Lodz, Kopcinskiego Street 22, 90-153 Lodz, Poland. durek@retsat1.com.pl
Telephone: +48-42-6776755 Fax: +48-42-6791091
Received: January 29, 2014
Revised: April 14, 2014
Accepted: June 14, 2014
Published online: September 28, 2014
Processing time: 245 Days and 13.8 Hours
Abstract

AIM: 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.

CONCLUSION: 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.

Keywords: Pancreatic cancer; D-dimers; Portal blood; Peripheral blood; Bile; Urine; Pancreatic cancer respectability

Core tip: High D-dimer level in patients with resectable pancreatic head cancer based on preoperative imaging studies predicts that tumor may be considered unresectable due to occult hepatic metastases. However, further multi-center studies are needed on high D-dimers in pancreatic head cancer and preoperative clinical decision making and surgical treatment. If verified, D-dimer testing should be performed in all subjects with pancreatic cancer.