Risk factors in predicting radiologically occult metastatic disease from pancreatic ductal adenocarcinoma: a single-institution experience with routine preoperative magnetic resonance imaging.

BACKGROUND

Limited data exist regarding the incidence of aborted pancreatic surgery owing to radiologically occult metastatic disease (ROMD). This study presents a single-institution experience aimed at identifying potential risk factors associated with ROMD of patients undergoing routine preoperative magnetic resonance imaging (MRI) with pancreatic ductal adenocarcinoma (PDAC).

METHODS

Patients with PDAC taken for curative-intent pancreatic surgery between January 2012 and December 2022 following a preoperative MRI protocol were retrospectively reviewed, and those who had aborted surgery owing to ROMD were identified. Binary logistic regression analysis was performed to identify potential predictors of ROMD.

RESULTS

A total of 440 patients were included; 18 (4.1%) had aborted surgery owing to ROMD. Younger age (P =.012), lower body mass index (BMI) (P =.032), weight loss (P =.020), tumor size (P =.039), and borderline resectable (BR)/locally advanced (LA) disease (P ≤.001) were associated with an increased risk of aborted surgery owing to ROMD in univariable regression; only BR/LA disease (P =.002) persisted as an independent risk factor in multivariable analysis. ROMD was not associated with preoperative cancer antigen 19-9 level.

CONCLUSION

Patients with BR/LA and even resectable PDAC remain at risk of aborted surgery owing to ROMD, with liver metastasis being the most common cause. BR/LA disease at presentation, along with young age, lower BMI, and larger tumor size, may predict those at greatest risk. MRI imaging may assist in decreasing the rates of ROMD and unnecessary surgery.