Preoperative model for predicting futility of upfront resection for anatomically resectable pancreatic ductal adenocarcinoma

There are currently no clinically relevant criteria to predict a futile upfront pancreatectomy, defined as an operation resulting in patient death or disease recurrence within 6 months, in patients with anatomically resectable pancreatic ductal adenocarcinoma (PDAC). In a retrospective study including 1426 patients of five centers in Italy, the rate of futile pancreatectomy was 18.9%. A preoperative model (‘MetroPancreas’) including American Society of Anesthesiologists class, cancer antigen 19.9 serum levels, and radiologic tumor size was implemented using a web-based calculator for personalized prediction. The risk of futile upfront pancreatectomy was less than 20% in patients with tumor size less that 2 cm and CA 19.9 levels below 1000 U/ml, in patients with tumor size less than 3 cm and CA 19.9 levels below 500 U/ml, in patients with tumor size less than 4 cm and CA 19.9 levels below 150 U/ml, and in patients with tumor size less than 5 cm and CA 19.9 levels below 50 U/ml. Both disease-free survival and overall survivalwere significantly longer in patients fulfilling these criteria. The authors conclude that these results demonstrate the ability to predict futile pancreatectomy could help select patients for upfront selection of neoadjuvant therapy.