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Background <p>A subset of patients with resectable pancreatic cancer (PC) experience early recurrence after curative-intent pancreatectomy and subsequently face a poor prognosis. However, the underlying factors associated with such a futility of surgery remain unclear.</p> Methods <p>This retrospective cohort study analyzed 369 patients with resectable PC who underwent curative pancreatectomy between 2008 and 2022. Futile surgery was defined as recurrence within 8 months postoperatively. Receiver operating characteristic curve and Youden’s index distribution were used to identify the optimal tumor diameter cutoff, which then was applied to survival analysis.</p> Results <p>A diameter of 3&#xa0;cm corresponded to the peak of Youden’s index and was adopted as the cutoff value. Patients were classifed into the large group (≥&#xa0;3&#xa0;cm; <i>n</i> = 206) and small group (&lt;&#xa0;3&#xa0;cm; <i>n</i> = 163). The median overall survival (OS) was significantly shorter in the large group (2.3 years) than in the small group (7.6 years) (<i>p</i> &lt; 0.01). The large group with neoadjuvant therapy had a median OS of 3.4 years, comparable with 2.3 years for the large group with upfront surgery (<i>p</i> = 0.33). Multivariable analysis identified the large group as a poor independent prognostic factor (hazard ratio, 2.2; <i>p</i> &lt; 0.01). Even after R0 resection, local recurrence was more frequently observed in the large group (34.1% vs 11.8%; <i>p</i> &lt; 0.01).</p> Conclusions <p>A tumor size of 3&#xa0;cm was associated with surgical futility in resectable pancreatic cancer and served as a useful factor for fine stratification of long-term postoperative outcomes.</p>

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Large Resectable Pancreatic Cancer is Associated with Futile Surgery: A Resectable But Not Curable Disease?

  • 期刊论文

  • 出版模式：

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  • 发表日期：

    2025年10月27日

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  • Sho Kiritani,
  • Yoshikuni Kawaguchi,
  • Yusuke Kazami,
  • Satoru Abe,
  • Yujiro Nishioka,
  • Yuichiro Mihara,
  • Akihiko Ichida,
  • Takeshi Takamoto,
  • Nobuhisa Akamatsu,
  • Kiyoshi Hasegawa

摘要

Background

A subset of patients with resectable pancreatic cancer (PC) experience early recurrence after curative-intent pancreatectomy and subsequently face a poor prognosis. However, the underlying factors associated with such a futility of surgery remain unclear.

Methods

This retrospective cohort study analyzed 369 patients with resectable PC who underwent curative pancreatectomy between 2008 and 2022. Futile surgery was defined as recurrence within 8 months postoperatively. Receiver operating characteristic curve and Youden’s index distribution were used to identify the optimal tumor diameter cutoff, which then was applied to survival analysis.

Results

A diameter of 3 cm corresponded to the peak of Youden’s index and was adopted as the cutoff value. Patients were classifed into the large group (≥ 3 cm; n = 206) and small group (< 3 cm; n = 163). The median overall survival (OS) was significantly shorter in the large group (2.3 years) than in the small group (7.6 years) (p < 0.01). The large group with neoadjuvant therapy had a median OS of 3.4 years, comparable with 2.3 years for the large group with upfront surgery (p = 0.33). Multivariable analysis identified the large group as a poor independent prognostic factor (hazard ratio, 2.2; p < 0.01). Even after R0 resection, local recurrence was more frequently observed in the large group (34.1% vs 11.8%; p < 0.01).

Conclusions

A tumor size of 3 cm was associated with surgical futility in resectable pancreatic cancer and served as a useful factor for fine stratification of long-term postoperative outcomes.