The Effects of Surgical Exploration on Survival of Unresectable Pancreatic Carcinoma: A Retrospective Case-Control Study

Abstract

Background: Surgery may trigger the release of inflammatory factors, including cytokines, growth factors and angiogenic factors, which may stimulate tumor growth and progression. The present study was undertaken to evaluate the impact of surgical exploration on survival of patients with potentially resectable pancreatic cancer, who intraoperatively were found to have unresectable disease. Methods: Patients with pancreatic adenocarcinoma undergoing surgical exploration, without tumor resection, at our institution between 2009 and 2014, were selected and case-matched to patients who underwent primary palliative treatment. Results: A total of 116 patients were included. The surgical exploration group (n = 29) had significantly lower CRP levels at the time of diagnosis compared to the palliative controls (n = 87), 4 mg/L vs 12 mg/L; p = 0.004. The percentage of patients who received palliative chemotherapy was comparable between groups, but the time until start of chemotherapy was significantly longer in the surgical exploration group, 2 months vs 1 months; p < 0.001. Median survival was 7.3 months (95% confidence interval (CI): 4.6 - 11.3 months) in the surgical exploration group and 6.8 months (95% CI: 4.7 - 8.6 months) in the palliative group, p = 0.898. In a multivariable Cox regression model, surgical exploration was not significantly associated with increased mortality risk (hazard ratio 1.06; 95% CI: 0.69 - 1.64, p = 0.782). Conclusion: In this case-control study, we could not detect any survival disadvantage due to surgical exploration in the setting of unresectable pancreatic cancer. Surgical exploration was associated with delayed start of palliative chemotherapy, but the percentage of patients who ultimately received chemotherapy was comparable to patients undergoing primary palliative treatment.