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What is the Significance of Indeterminate Pulmonary Nodules in Patients Undergoing Resection for Pancreatic Adenocarcinoma?

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Journal of Gastrointestinal Surgery Aims and scope

Abstract

Objective

The significance of indeterminate pulmonary nodules (IPNs) in patients undergoing resection of pancreatic ductal adenocarcinoma (PDAC) is unknown. We sought to define the prevalence and impact of IPN in such patients.

Methods

We studied all patients who underwent surgical resection of PDAC between 1980 and 2013. IPN was defined as ≥1 well-defined lung nodule(s) less than 3 cm in diameter. Survival was assessed using univariate and multivariate Cox models.

Results

Of the 2306 resected patients, 374 (16.2 %) had a preoperative chest computed tomography (CT) scan. Of these patients, 183 (49 %) had ≥1 IPN. Demographic and clinicopathological characteristics were similar among patients with or without IPN (all P > 0.05). Median survival was comparable among patients who did (15.6 months) or did not (18.0 months) have IPN (P = 0.66). Of the 183 patients with IPN, 29 (16 %) progressed to clinically recognizable metastatic lung disease compared to 13 % without IPN (P = 0.38). The presence of >1 IPN was associated with the development of lung metastasis (relative risk 1.58, 95 % CI 1.03–2.4; P = 0.05). However, lung metastasis was not associated with survival (P = 0.24).

Conclusions

An IPN proved to be a lung metastasis in only one of six patients with PDAC undergoing surgical resection in this study. Survival was not impacted, even among patients who developed lung metastasis. Patients with PDAC who have IPN should not be precluded from surgical consideration.

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Acknowledgments

The authors of this manuscript do not have any financial or material support to acknowledge.

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Authors and Affiliations

  1. Department of Surgery, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Halsted 608, 600 N. Wolfe Street, Baltimore, MD, 21287, USA

    Katherine E. Poruk, Yuhree Kim, John L. Cameron, Jin He, Frederic E. Eckhauser, Neda Rezaee, Timothy M. Pawlik, Christopher L. Wolfgang & Matthew J. Weiss

  2. Department of Radiation Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Joseph Herman

  3. Department of Medical Oncology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Daniel Laheru & Lei Zheng

  4. Department of Radiology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Elliot K. Fishman

  5. Department of Surgery Pathology, The Sol Goldman Pancreatic Cancer Research Center, The Johns Hopkins University School of Medicine, Baltimore, MD, 21287, USA

    Ralph H. Hruban

Authors
  1. Katherine E. Poruk
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  2. Yuhree Kim
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  3. John L. Cameron
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  4. Jin He
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  5. Frederic E. Eckhauser
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  6. Neda Rezaee
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  7. Joseph Herman
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  8. Daniel Laheru
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  9. Lei Zheng
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  10. Elliot K. Fishman
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  11. Ralph H. Hruban
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  12. Timothy M. Pawlik
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  13. Christopher L. Wolfgang
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  14. Matthew J. Weiss
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Corresponding author

Correspondence to Matthew J. Weiss.

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Poruk, K.E., Kim, Y., Cameron, J.L. et al. What is the Significance of Indeterminate Pulmonary Nodules in Patients Undergoing Resection for Pancreatic Adenocarcinoma?. J Gastrointest Surg 19, 841–847 (2015). https://doi.org/10.1007/s11605-014-2740-9

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  • DOI: https://doi.org/10.1007/s11605-014-2740-9

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