Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer

Marcia Canto, Tossapol Kerdsirichairat, Charles J. Yeo, Ralph H Hruban, Eun Shin, Jose Alejandro Almario, Amanda Blackford, Madeline Ford, Alison Klein, Ammar A. Javed, Anne Marie O'Broin-Lennon, Atif Zaheer, Ihab R Kamel, Elliot K Fishman, Richard Burkhart, Jin He, Martin A Makary, Matthew J Weiss, Richard D. Schulick, Michael S Goggins & 1 others Christopher Wolfgang

Research output: Contribution to journalArticle

Abstract

Background: Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. Methods: Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. Results: Among 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. Conclusions: Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration Number: NCT2000089.

Original languageEnglish (US)
JournalJournal of Gastrointestinal Surgery
DOIs
StatePublished - Jan 1 2019

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Pancreatic Neoplasms
Pancreatectomy
Length of Stay
Adenocarcinoma
Mortality
Diabetes Mellitus
Morbidity
Germ-Line Mutation
Early Detection of Cancer
Pancreas
Pathologic Constriction
Clinical Trials
Incidence

Keywords

  • Early detection
  • Pancreatic cancer
  • Screening
  • Surgical outcomes

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

@article{fd7aa42a2f6b474a970af4e70df600fd,
title = "Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer",
abstract = "Background: Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. Methods: Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. Results: Among 354 HRI, 48 (13.6{\%}) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35{\%}); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20{\%} of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40{\%}), with 90{\%} 1-year survival and 60{\%} 5-year survival, respectively. Conclusions: Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration Number: NCT2000089.",
keywords = "Early detection, Pancreatic cancer, Screening, Surgical outcomes",
author = "Marcia Canto and Tossapol Kerdsirichairat and Yeo, {Charles J.} and Hruban, {Ralph H} and Eun Shin and Almario, {Jose Alejandro} and Amanda Blackford and Madeline Ford and Alison Klein and Javed, {Ammar A.} and O'Broin-Lennon, {Anne Marie} and Atif Zaheer and Kamel, {Ihab R} and Fishman, {Elliot K} and Richard Burkhart and Jin He and Makary, {Martin A} and Weiss, {Matthew J} and Schulick, {Richard D.} and Goggins, {Michael S} and Christopher Wolfgang",
year = "2019",
month = "1",
day = "1",
doi = "10.1007/s11605-019-04230-z",
language = "English (US)",
journal = "Journal of Gastrointestinal Surgery",
issn = "1091-255X",
publisher = "Springer New York",

}

TY - JOUR

T1 - Surgical Outcomes After Pancreatic Resection of Screening-Detected Lesions in Individuals at High Risk for Developing Pancreatic Cancer

AU - Canto, Marcia

AU - Kerdsirichairat, Tossapol

AU - Yeo, Charles J.

AU - Hruban, Ralph H

AU - Shin, Eun

AU - Almario, Jose Alejandro

AU - Blackford, Amanda

AU - Ford, Madeline

AU - Klein, Alison

AU - Javed, Ammar A.

AU - O'Broin-Lennon, Anne Marie

AU - Zaheer, Atif

AU - Kamel, Ihab R

AU - Fishman, Elliot K

AU - Burkhart, Richard

AU - He, Jin

AU - Makary, Martin A

AU - Weiss, Matthew J

AU - Schulick, Richard D.

AU - Goggins, Michael S

AU - Wolfgang, Christopher

PY - 2019/1/1

Y1 - 2019/1/1

N2 - Background: Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. Methods: Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. Results: Among 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. Conclusions: Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration Number: NCT2000089.

AB - Background: Screening high-risk individuals (HRI) can detect potentially curable pancreatic ductal adenocarcinoma (PDAC) and its precursors. We describe the outcomes of high-risk individuals (HRI) after pancreatic resection of screen-detected neoplasms. Methods: Asymptomatic HRI enrolled in the prospective Cancer of the Pancreas Screening (CAPS) studies from 1998 to 2014 based on family history or germline mutations undergoing surveillance for at least 6 months were included. Pathologic diagnoses, hospital length of stay, incidence of diabetes mellitus, operative morbidity, need for repeat operation, and disease-specific mortality were determined. Results: Among 354 HRI, 48 (13.6%) had 57 operations (distal pancreatectomy (31), Whipple (20), and total pancreatectomy (6)) for suspected pancreatic neoplasms presenting as a solid mass (22), cystic lesion(s) (25), or duct stricture (1). The median length of stay was 7 days (IQR 5–11). Nine of the 42 HRI underwent completion pancreatectomy for a new lesion after a median of 3.8 years (IQR 2.5–7.6). Postoperative complications developed in 17 HRI (35%); there were no perioperative deaths. New-onset diabetes mellitus after partial resection developed in 20% of HRI. Fourteen PDACs were diagnosed, 11 were screen-detected, 10 were resectable, and 9 had an R0 resection. Metachronous PDAC developed in remnant pancreata of 2 HRI. PDAC-related mortality was 4/10 (40%), with 90% 1-year survival and 60% 5-year survival, respectively. Conclusions: Screening HRI can detect PDAC with a high resectability rate. Surgical treatment is associated with a relatively short length of stay and low readmission rate, acceptable morbidity, zero 90-day mortality, and significant long-term survival. Clinical Trial Registration Number: NCT2000089.

KW - Early detection

KW - Pancreatic cancer

KW - Screening

KW - Surgical outcomes

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U2 - 10.1007/s11605-019-04230-z

DO - 10.1007/s11605-019-04230-z

M3 - Article

JO - Journal of Gastrointestinal Surgery

JF - Journal of Gastrointestinal Surgery

SN - 1091-255X

ER -