Is the size of pancreatic head carcinoma a reliable prognostic factor?

Abstract

BACKGROUND: Surgical R0 resection is a must in the treatment strategy of pancreatic head ductal adenocarcinoma (PHDAC). The small tumour size (≤ 2 cm) predicts radical removal and benefits long-term results.
MATERIAL AND METHODS: A total of 695 patients with PHDAC received surgery at the authors’ institution between 2007–2020. All the medical records were revised, emphasising preoperative diagnostic imaging data, intraoperative findings and pathological reports. One hundred and seven cases were included in a retrospective study based on precise tumour size data: Group of Small (< 20mm) PHDAC - n=14; Group of Large (> 35mm) PHDAC - n=93. Results were compared and analysed by statistical methods (Pearson Chi-Square, Risk Estimate and Odds ratio for tumour size). 
RESULTS: Large PHDAC and Small PDHAC allowed R0 resection in 7.5% (n=7/93) and 92.9% (n=13/14), respectively (Pearson Chi-Square=58.2; p< 0.005). The risk of irresectability for Large PHDAC swas 159.7 times greater than for Small PHDACs. Patients with Large PHDAC must not be treated as foredoomed. However, such a size reduced the chance of radical surgery 12.9 times (р < 0.005). No mortality was registered in the early postoperative period. The morbidity rates did not differ significantly in both groups. The lymph node status demonstrated no dependence on tumour size.
CONCLUSION: Tumour size is a reliable predictive factor for the respectability of PHDAC but does not influence early postoperative results. Most of the literature data definitively proves the importance of small tumour size for better late results.