Annals of Surgical Oncology

, Volume 20, Issue 2, pp 357–361 | Cite as

Survival Among Pancreaticoduodenectomy Patients Treated for Pancreatic Head Cancer <1 or 2 cm

  • Jan Franko
  • Vladimir Hugec
  • Tercio L. Lopes
  • Charles D. Goldman
Healthcare Policy and Outcomes



Size of primary tumor has implications for staging, imaging, and treatment of pancreatic head carcinomas. Limited data suggest that small tumor size is associated with better survival. The objective of this population study is to analyze characteristics and survival of patients with resected pancreatic head ductal carcinomas sized <1 and 2 cm.


Analysis of resected invasive pancreatic head ductal carcinomas captured within SEER Program from 1998 to 2008.


A total of 7,135 cases were analyzed with nodal metastases in 31, 55, and 67 % for subcentimeter, 1.1–2 cm, and >2 cm tumors, respectively. Median survival was longest for node-negative tumors (38, 26, 19 months for tumors measuring ≤1, 1.1–2, and >2 cm, respectively; p < 0.001) versus node-positive tumors (18, 19, 14 months, p < 0.001). In multivariate analysis, large tumor size was associated with higher risk of death (hazard ratio (HR) = 1.179 for tumors 1.1–2 cm, p = 0.152; HR = 1.665 for tumors >2 cm, p < 0.001).


Small pancreatic cancers have a poor prognosis and surprisingly high rate of nodal involvement; therefore, they cannot be considered early cancers. Size-based screening is unlikely to save lives with current treatment options.


Pancreatic Cancer Pancreatic Head Intraductal Papillary Mucinous Neoplasm Pancreatic Head Cancer Pancreatic Head Carcinoma 
These keywords were added by machine and not by the authors. This process is experimental and the keywords may be updated as the learning algorithm improves.



There are no financial disclosures from any authors.


  1. 1.
    Brennan MF, Kattan MW, Klimstra D, et al. Prognostic nomogram for patients undergoing resection for adenocarcinoma of the pancreas. Ann Surg. 2004;240:293–8.PubMedCrossRefGoogle Scholar
  2. 2.
    Brennan MF, Moccia RD, Klimstra D. Management of adenocarcinoma of the body and tail of the pancreas. Ann Surg. 1996;223:506–11. discussion 511-2.PubMedCrossRefGoogle Scholar
  3. 3.
    Cameron JL, Crist DW, Sitzmann JV, et al. Factors influencing survival after pancreaticoduodenectomy for pancreatic cancer. Am J Surg. 1991;161:120–4. discussion 124-5.PubMedCrossRefGoogle Scholar
  4. 4.
    Neoptolemos JP, Stocken DD, Friess H, et al. A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med. 2004;350:1200–10.PubMedCrossRefGoogle Scholar
  5. 5.
    Haeno H, Gonen M, Davis MB, et al. Computational modeling of pancreatic cancer reveals kinetics of metastasis suggesting optimum treatment strategies. Cell. 2012;148:362–75.PubMedCrossRefGoogle Scholar
  6. 6.
    Hruban RH, Goggins M, Parsons J, et al. Progression model for pancreatic cancer. Clin Cancer Res. 2000;6:2969–72.PubMedGoogle Scholar
  7. 7.
    Yachida S, Jones S, Bozic I, et al. Distant metastasis occurs late during the genetic evolution of pancreatic cancer. Nature. 2010;467:1114–7.PubMedCrossRefGoogle Scholar
  8. 8.
    Rhim AD, Mirek ET, Aiello NM, et al. EMT and dissemination precede pancreatic tumor formation. Cell. 2012;148:349–61.PubMedCrossRefGoogle Scholar
  9. 9.
    Al-Sukhni W, Borgida A, Rothenmund H, Holter S, Wilson S, Moore MJ, Narod S, Jhaveri K, Haider MA, Gallinger S. Screening for pancreatic cancer in a high-risk cohort: a 7-year experience. J Clin Oncol. 2011;29:4045.CrossRefGoogle Scholar
  10. 10.
    Vasen HF, Wasser M, van Mil A, et al. Magnetic resonance imaging surveillance detects early-stage pancreatic cancer in carriers of a p16-Leiden mutation. Gastroenterology. 2011;140:850–6.PubMedCrossRefGoogle Scholar
  11. 11.
    Chiang KC, Yeh CN, Lee WC, et al. Prognostic analysis of patients with pancreatic head adenocarcinoma less than 2 cm undergoing resection. World J Gastroenterol. 2009;15:4305–10.PubMedCrossRefGoogle Scholar
  12. 12.
    Jung KW, Kim MH, Lee TY, et al. Clinicopathological aspects of 542 cases of pancreatic cancer: a special emphasis on small pancreatic cancer. J Korean Med Sci. 2007;22(Suppl):S79–85.PubMedCrossRefGoogle Scholar
  13. 13.
    Ariyama J, Suyama M, Satoh K, et al. Imaging of small pancreatic ductal adenocarcinoma. Pancreas. 1998;16:396–401.PubMedCrossRefGoogle Scholar
  14. 14.
    Ishikawa O, Ohigashi H, Imaoka S, et al. Minute carcinoma of the pancreas measuring 1 cm or less in diameter-collective review of Japanese case reports. Hepatogastroenterology. 1999;46:8–15.PubMedGoogle Scholar
  15. 15.
    Tsunoda T, Yamamoto Y, Kimoto M, et al. Staging and treatment for patients with pancreatic cancer. How small is an early pancreatic cancer? J Hepatobiliary Pancreat Surg. 1998;5:128–32.PubMedCrossRefGoogle Scholar
  16. 16.
    Furukawa H, Okada S, Saisho H, et al. Clinicopathologic features of small pancreatic adenocarcinoma. A collective study. Cancer. 1996;78:986–90.PubMedCrossRefGoogle Scholar
  17. 17.
    NCI. Surveillance, Epidemiology, and End Results (SEER) Program Limited-Use Data (1973–2008), National Cancer Institute, DCCPS, Surveillance Research Program, Cancer Statistics Branch, based on the November 2010 submission, 2011.Google Scholar
  18. 18.
    Nitecki SS, Sarr MG, Colby TV, et al. Long-term survival after resection for ductal adenocarcinoma of the pancreas. Is it really improving? Ann Surg. 1995;221:59–66.PubMedCrossRefGoogle Scholar
  19. 19.
    Bilimoria KY, Bentrem DJ, Ko CY, et al. Validation of the 6(th) edition AJCC pancreatic cancer staging system: report from the National Cancer Database. Cancer. 2007;110:738–44.PubMedCrossRefGoogle Scholar
  20. 20.
    Sohn TA, Yeo CJ, Cameron JL, et al. Intraductal papillary mucinous neoplasms of the pancreas: an updated experience. Ann Surg. 2004;239:788–97; discussion 797-9.Google Scholar
  21. 21.
    Hsu CC, Herman JM, Corsini MM, et al. Adjuvant chemoradiation for pancreatic adenocarcinoma: the Johns Hopkins Hospital–Mayo Clinic collaborative study. Ann Surg Oncol. 2010;17:981–90.PubMedCrossRefGoogle Scholar
  22. 22.
    Bilimoria KY, Bentrem DJ, Merkow RP, et al. Application of the pancreatic adenocarcinoma staging system to pancreatic neuroendocrine tumors. J Am Coll Surg. 2007;205:558–63.PubMedCrossRefGoogle Scholar
  23. 23.
    Cameron JL, Riall TS, Coleman J, et al. One thousand consecutive pancreaticoduodenectomies. Ann Surg. 2006;244:10–5.PubMedCrossRefGoogle Scholar
  24. 24.
    Franko J, Krasinskas AM, Nikiforova MN, et al. Loss of heterozygosity predicts poor survival after resection of pancreatic adenocarcinoma. J Gastrointest Surg. 2008;12:1664–72; discussion 1672–3.Google Scholar
  25. 25.
    Franko J, Bilimoria MM, Chalikonda S, et al. Pattern of in vitro chemotherapy response in pancreatic cancer and its clinical implication. ASCO Meeting Abstracts. 2011;29:229.Google Scholar
  26. 26.
    Okazaki T, Jiao L, Chang P, et al. Single-nucleotide polymorphisms of DNA damage response genes are associated with overall survival in patients with pancreatic cancer. Clin Cancer Res. 2008;14:2042–8.PubMedCrossRefGoogle Scholar
  27. 27.
    Cotton RT, Li D, Scherer SE, et al. Single nucleotide polymorphism in RECQL and survival in resectable pancreatic adenocarcinoma. HPB (Oxford). 2009;11:435–44.CrossRefGoogle Scholar

Copyright information

© Society of Surgical Oncology 2012

Authors and Affiliations

  • Jan Franko
    • 1
  • Vladimir Hugec
    • 2
  • Tercio L. Lopes
    • 3
  • Charles D. Goldman
    • 1
  1. 1.Mercy Medical CenterDes MoinesUSA
  2. 2.Maplewood Cancer CenterMaplewoodUSA
  3. 3.Iowa Digestive Disease CenterCliveUSA

Personalised recommendations