S. Gopinath1, U. Ballehaninna1, R. S. Chamberlain1,2,3 1Saint Barnabas Medical Center,Department Of Surgery,Livingston, NJ, USA 2Rutgers University, New Jersey Medical School,Department Of Surgery,Newark, NJ, USA 3Saint George’s University,Department Of Surgery,Grenada, Grenada, Grenada
Introduction: Serum CA 19-9 levels assessment is a cornerstone of pancreatic cancer management as it plays an important role in the diagnosis, prognosis, response to treatment and staging. To date very few studies have assessed whether preoperative serum CA 19-9 levels can reliably predict laparoscopic findings, in terms of both resectability and the identification of pancreatic cancer metastases in pancreatic cancer patients deemed resectable on traditional imaging studies.
Methods: Clinico-pathologic characteristics including serum CA 19-9 levels were prospectively collected in 58 patients with pancreatic cancer deemed resectable by preoperative work up. Intraoperative data collection included findings at laparoscopy (peritoneal and liver metastasis) and/or operative exploration (resectable or unresectable). Wilcoxon-Rank- Sum test was used to determine whether preoperative serum CA 19-9 levels correlated with findings at laparoscopy, assess tumor resectability and staging.
Results:Fifty-eight patients with pancreatic cancer underwent diagnostic laparoscopy followed by surgical exploration with curative intent. Mean age was 67.5 years (range, 43-88 years). Preoperative serum CA 19-9 levels in these patients ranged from 2-3344 u/ml. Peritoneal or liver metastasis was identified by laparoscopy in 23 patients (40%) whereas 35 patients (60%) underwent curative pancreatic resection. Mean serum CA 19-9 levels for resectable tumors were 927.5 u/ml (range; 9-6137) compared to 2362.9 u/ml (range 2-26871) in unresectable tumors. A mean serum CA 19-9 level of 2362.9 u/ml was statistically significant in predicting inoperable pancreatic tumor at the time of laparoscopy. A linear correlation of serum CA 19-9 levels with pancreatic cancer stage was also observed (Figure)
Conclusion:Preoperative serum CA 19-9 levels have excellent correlation with diagnostic laparoscopy findings in regards to determining pancreatic cancer resectability. Given the wide range of serum CA-19-9 levels observed in this small study, large scale studies are necessary to more precisely define more narrow serum CA-1-9-9 levels that can be used clinically to accurately predict pancreatic cancer stage and to differentiate resectable from unresectable pancreatic cancer.
