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

[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.