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Publications

Journal Article Ahead of print

PubMed: 42157261 DOI: 10.1186/s12957-026-04351-1

Futility in adenosquamous pancreatic cancer.

World J Surg Oncol

Authors: Jose Manuel Ramia, Celia Villodre, Dimitrios Giakoustidis, Paraskevi Chatzikomnitsa, Pietro Addeo, Philippe Bachellier, Gennaro Nappo, Alessandro Zerbi, Julie Navez, Gerardo Blanco-Fernández, Jakob Kirkegård, Juli Busquets, Bergthor Björnsson, Santiago Sánchez-Cabús, Elizabeth Pando, Sebastian Manuel Staubli, Sanjay Pandanaboyana, Daniel Aparicio-López, Harry Vm Spiers, Paola Melgar, Rami Rhaiem, Maria João Amaral, Cristina Vallejo-Bernad, Bodil Andersson, Fernando Burdío, George Tzimas, Isabel Mora-Oliver, Michael Rousek, Carlos Domingo-Del-Pozo, Ahmad Mahamid, Dimitrios Lytras, Evangelos D Lolis, Rafael López-Andújar, María Sorribas, Pablo Alejandro López, Hassan Elghonemy, Bhargava Chikkala, Weiboom Lim, Anita Balakrishnan, María Villamonte Román, Cristina Ballester, Carlos Hörndler-Algárate, Mario Serradilla-Martín

Affiliations

  • Department of Surgery, Hospital General Universitario Dr. Balmis, Alicante, Spain.
  • Instituto de Investigación Sanitaria y Biomédica, Alicante, Spain.
  • Universidad Miguel Hernández, Campus Sant Joan Alicante, Alicante, Spain.
  • Department of Surgery, Papageorgiou General Hospital, Thessaloniki, Greece.
  • Department of Surgery, Hepato-Pancreato-Biliary Surgery and Liver Transplantation, Pôle des Pathologies Hépatiques et Digestives, Hôpital de Hautepierre-Hôpitaux Universitaires de Strasbourg, Université de Strasbourg, Strasbourg, France.
  • Department of Biomedical Sciences, Pancreatic Surgery Unit, Humanitas University, Humanitas Clinical and Research Centre, IRCCS, Milan, Italy.
  • Department of Abdominal Surgery and Transplantation, Hôpital Universitaire de Bruxelles, Université Libre de Bruxelles, Brussels, Belgium.
  • School of Medicine, Department of Surgery, University of Extremadura, Hospital Universitario de Badajoz, Instituto Universitario de Investigación Biosanitaria de Extremadura, Badajoz, Spain.
  • Department of Surgery, HPB Section, Institute for Clinical Medicine, Aarhus University Hospital, Aarhus University, Aarhus, Denmark.
  • Department of Surgery, Hospital Universitario de Bellvitge, Hospitalet de Llobregat, Barcelona, Spain.
  • Department of Biomedical and Clinical Sciences, Clinical Department of Surgery in Linköping, Linköping University, Region Östergötland, Linköping, Sweden.
  • Department of Surgery, Hospital Universitario de la Santa Creu i Sant Pau, Barcelona, Spain.
  • Department of Surgery, Hospital Universitario Vall d'Hebron, Barcelona, Spain.
  • Department of Surgery, Royal Free Hospital, London, UK.
  • Department of Surgery, Freeman Hospital, Newcastle upon Tyne, UK.
  • Department of Surgery, Hospital Universitario San Jorge, Huesca, Spain.
  • Department of Surgery, Cambridge University Hospital, Cambridge, UK.
  • Department of Surgery, CHU Reims, Reims, France.
  • Department of Surgery, Unidade Local de Saúde de Coimbra, Coimbra, Portugal.
  • Department of Surgery, Hospital Universitario San Pedro, Logroño, Spain.
  • Department of Clinical Sciences Lund, Surgery, Lund University and Skane University Hospital, Lund, Sweden.
  • Department of Surgery, Hospital de Mar, Barcelona, Spain.
  • Department of Surgery, Hygeia Hospital, Athens, Greece.
  • Liver, Biliary and Pancreatic Surgery Unit, Department of General and Digestive Surgery, Department of Surgery, Hospital Clínico Universitario de Valencia, University of Valencia. Biomedical Research Institute, INCLIVA, Valencia, Spain.
  • Department of Surgery, Second Faculty of Medicine of Charles University, Military University Hospital, Prague, Czech Republic.
  • Department of Surgery, Hospital Universitario Dr. Peset, Valencia, Spain.
  • Rappaport Faculty of Medicine, Department of Surgery, HPB Surgery Unit, Technion Israel Institute of Technology, Carmel Medical Center, Haifa, Israel.
  • Department of Surgery, General Hospital of Volos, Thessalia, Greece.
  • Department of Surgery, General Hospital of Chania, Crete, Greece.
  • Department of Surgery, Hospital Universitario y Politécnico La Fe, Valencia, Spain.
  • Department of Pathology, Hospital Universitario Miguel Servet, Zaragoza, Spain.
  • Department of Surgery, Instituto de Investigación Biosanitaria Ibs.GRANADA, Hospital Universitario Virgen de Las Nieves, School of Medicine, University of Granada, Av. de las Fuerzas Armadas, 2, Granada, 18014, Spain.

Abstract

BACKGROUND

Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer with a dismal prognosis. Futility in ASCP has been inadequately studied. The aim is to assess the incidence of futility in ASCP cases within a European cohort.

METHODS

Retrospective, multicenter European study including all consecutive patients who underwent surgery for ASCP between 2010 and 2024.

INCLUSION CRITERIA

patients operated for ASCP during the study period.

EXCLUSION CRITERIA

patients without a confirmed pathological diagnosis of ASCP, those who did not undergo surgery, or had extra-pancreatic disease. A pancreatectomy was considered futile if a patient died from postoperative complications within 90 days, or if cancer-related mortality or recurrence occurred within 6 months of the operation.

RESULTS

194 patients from 29 hospitals in 11 European countries were studied. Surgeries included 125 pancreaticoduodenectomies, 59 left pancreatectomies, and 10 total pancreatectomies. Major complications were observed in 25.3% of patients. Postoperative mortality was 5.7%. The rate of futility was 47.9%. Eleven patients (11,8%) died from postoperative complications, 69 patients (74,2%) had recurrence, and 13 patients (14%) died within 6 months due to cancer. In the multivariate analysis, a positive retroperitoneal margin, lymphatic invasion, and not receiving chemotherapy were associated with futility.

CONCLUSIONS

The futility observed in ASCP is notably high and related to a positive retroperitoneal margin, lymphatic invasion, and not receiving adjuvant chemotherapy. Defining futile patients with an international consensus definition is crucial and has significant implications for shared decision-making and care optimization.

MeSH

Pancreatic Neoplasms, Mortality, Neoplasms, Drug Therapy, Postoperative Complications, Pancreatectomy, Chemotherapy