Incidence and risk factors for abdominal occult metastatic disease in patients with pancreatic adenocarcinoma

Georgios Gemenetzis, Vincent P. Groot, Alex B. Blair, Ding Ding, Sameer S. Thakker, Elliot K Fishman, John L Cameron, Martin A Makary, Matthew J Weiss, Christopher Wolfgang, Jin He

Research output: Contribution to journalArticle


Background: The incidence of occult metastatic disease (OMD) in pancreatic ductal adenocarcinoma (PDAC) and associated risk factors are largely unknown. Methods: We identified all patients with PDAC, who had an aborted oncologic operation due to OMD within a 10-year period. The cases were matched to a cohort of resected PDAC patients on a 1:3 ratio, based on age and sex, for comparison of preoperative clinical characteristics and potential risk factors for OMD. Results: In the studied period, 117 patients with OMD were identified in 1423 pancreatectomies performed for PDAC (8%). Liver metastases were the most common finding (79%) followed by peritoneal implants (16%). When compared with non-OMD cases, patients with OMD presented more often with abdominal pain (P < 0.001), and higher preoperative carbohydrate antigen 19-9 (CA 19-9) values (P = 0.007). Additionally, indeterminate liver lesions on preoperative computed tomography (CT) were identified in 40% of OMD versus 17% of non-OMD patients (P < 0.001). Multivariable analysis distinguished four independent predictors for OMD: indeterminate lesions on preoperative CT, tumor size > 30 mm, abdominal pain, and preoperative CA 19-9 > 192 U/mL. Conclusions: Occurrence of OMD in PDAC accounts for 8% of cases. Preoperative CA 19-9 > 192 U/mL, primary tumor size > 30 mm, and identification of indeterminate lesions in preoperative CT may indicate the need for diagnostic laparoscopy.

Original languageEnglish (US)
JournalJournal of Surgical Oncology
StateAccepted/In press - Jan 1 2018


  • diagnostic laparoscopy
  • indeterminate lesions
  • metastases
  • occult
  • pancreatic cancer

ASJC Scopus subject areas

  • Surgery
  • Oncology

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