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Asymptomatic Pancreatic Cancer: Does Incidental Detection Impact Long-Term Outcomes?

  • Original Article
  • Published:
Journal of Gastrointestinal Surgery Aims and scope

Abstract

Background

Detection of pancreatic ductal adenocarcinoma (PDAC) in asymptomatic patients is very rare, and the clinical implication of early detection of asymptomatic PDAC remains unclear.

Methods

This retrospective study included 569 consecutive patients with PDAC treated in our institution (250 underwent surgical resection and 319 had unresectable PDAC). The patients’ demographics, tumor locations, pathologic stages, treatment, and overall survival (OS) were compared between the asymptomatic and symptomatic patients.

Results

In total, 163 (29%) patients presented without subjective symptoms. These patients had an earlier stage of PDAC on presentation (p < 0.001), higher resectability rate (64 vs. 36%, p < 0.001), and higher 5-year OS rate (18 vs. 7%, p < 0.001) than patients with symptoms. Among the patients who underwent resection, asymptomatic patients did not have a significantly higher chance of complete resection (88 vs. 78%, p = 0.06) or 5-year OS rate (23 vs. 22%, p = 0.09). However, symptomatic patients more often required complex operations such as concomitant vascular resection and reconstruction (57 vs. 29%, p < 0.001).

Conclusions

Asymptomatic PDAC is associated with better long-term outcomes than symptomatic PDAC because of the earlier stage at presentation and higher chance of resectability. Our findings highlight the potential implication of screening programs for early detection of PDAC in selected high-risk populations.

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Acknowledgements

This study was supported by a grant from the Project for Development of Innovative Research on Cancer Therapeutics (P-Direct) and the Japan Agency for Medical Research and Development.

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Authors and Affiliations

  1. Department of Hepato-Biliary-Pancreatic Surgery, Cancer Institute Hospital, Japanese Foundation for Cancer Research, 3-8-31 Ariake, Koto-ku, Tokyo, 135-8550, Japan

    Yoshinori Takeda, Akio Saiura, Yu Takahashi, Yosuke Inoue, Takeaki Ishizawa, Yoshihiro Mise, Masaru Matsumura, Hirofumi Ichida, Ryota Matsuki, Masayuki Tanaka & Hiromichi Ito

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  1. Yoshinori Takeda
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  2. Akio Saiura
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  3. Yu Takahashi
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  4. Yosuke Inoue
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  5. Takeaki Ishizawa
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  6. Yoshihiro Mise
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  7. Masaru Matsumura
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  8. Hirofumi Ichida
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  9. Ryota Matsuki
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  10. Masayuki Tanaka
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  11. Hiromichi Ito
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Contributions

YT—conception or design of the work and drafting the work

AS—conception or design of the work and critical revision of the work

YT—conception or design of the work and critical revision of the work

YI—conception or design of the work and critical revision of the work

TI—conception or design of the work and critical revision of the work

YM—conception or design of the work and critical revision of the work

MM—acquisition of data for the work and critical revision of the work

HI—acquisition of data for the work and critical revision of the work

RM—acquisition of data for the work and critical revision of the work

MT—acquisition of data for the work and critical revision of the work

HI—conception or design of the work and drafting and critical revision of the work

All authors approved the version of the manuscript to be published and agreed to be accountable for all aspects of the work in ensuring that questions related to the accuracy and integrity of any part of the work were appropriately investigated and resolved.

Corresponding author

Correspondence to Akio Saiura.

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This study was approved by the Cancer Institute Hospital Institutional Review Board (2015-1078).

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Cite this article

Takeda, Y., Saiura, A., Takahashi, Y. et al. Asymptomatic Pancreatic Cancer: Does Incidental Detection Impact Long-Term Outcomes?. J Gastrointest Surg 21, 1287–1295 (2017). https://doi.org/10.1007/s11605-017-3421-2

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  • DOI: https://doi.org/10.1007/s11605-017-3421-2

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