Very high serum CA 19-9 levels: A contraindication to pancreaticoduodenectomy?

O. Turrini, C. Schmidt, J. Moreno, P. Parikh, J. M. Matos, Michael House, Nicholas Zyromski, Attila Nakeeb, H. A. Pitt, K. D. Lillemoe

Research output: Contribution to journalArticle

21 Citations (Scopus)

Abstract

Aim To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels. Methods From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.Results Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.Conclusions Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

Original languageEnglish
Pages (from-to)1791-1797
Number of pages7
JournalJournal of Gastrointestinal Surgery
Volume13
Issue number10
DOIs
StatePublished - Sep 2009

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Pancreaticoduodenectomy
Serum
Survival
Control Groups
Adenocarcinoma
Obstructive Jaundice

Keywords

  • CA 19-9
  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology

Cite this

Very high serum CA 19-9 levels : A contraindication to pancreaticoduodenectomy? / Turrini, O.; Schmidt, C.; Moreno, J.; Parikh, P.; Matos, J. M.; House, Michael; Zyromski, Nicholas; Nakeeb, Attila; Pitt, H. A.; Lillemoe, K. D.

In: Journal of Gastrointestinal Surgery, Vol. 13, No. 10, 09.2009, p. 1791-1797.

Research output: Contribution to journalArticle

Turrini, O. ; Schmidt, C. ; Moreno, J. ; Parikh, P. ; Matos, J. M. ; House, Michael ; Zyromski, Nicholas ; Nakeeb, Attila ; Pitt, H. A. ; Lillemoe, K. D. / Very high serum CA 19-9 levels : A contraindication to pancreaticoduodenectomy?. In: Journal of Gastrointestinal Surgery. 2009 ; Vol. 13, No. 10. pp. 1791-1797.
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abstract = "Aim To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels. Methods From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.Results Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32{\%} versus 14{\%} (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.Conclusions Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.",
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T2 - A contraindication to pancreaticoduodenectomy?

AU - Turrini, O.

AU - Schmidt, C.

AU - Moreno, J.

AU - Parikh, P.

AU - Matos, J. M.

AU - House, Michael

AU - Zyromski, Nicholas

AU - Nakeeb, Attila

AU - Pitt, H. A.

AU - Lillemoe, K. D.

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N2 - Aim To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels. Methods From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.Results Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.Conclusions Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

AB - Aim To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels. Methods From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.Results Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.Conclusions Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

KW - CA 19-9

KW - Pancreatic adenocarcinoma

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KW - Pancreaticoduodenectomy

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