Local Invasion of Pancreatic Cancer

• Primary outcome: Frequency of local invasion modalities in surgical population [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  We will review the clinical and pathology information from the CUMC surgical database to determine the frequency of the various modalities of local invasion of pancreatic adenocarcinoma. This includes: peripancreatic fat invasion, neural/perineural invasion, vascular invasion, macrovascular invasion, duodenal invasion, bile duct invasion, splenic invasion,and gastric invasion.
  
  

• Secondary Outcome: Understanding the natural history of local invasion [ Time Frame: 1 year ] [ Designated as safety issue: No ]
  We will also record several characteristics of the tumor, preoperative treatment, and surgical course including: neoadjuvant chemotherapy, histology, type of surgery, margins, and number of lymph nodes dissected. In addition, we will also record several demographic parameters, including, age, age at surgery, race, gender, tobacco history, family history, and pre-operative imaging. Understanding the natural history of local invasion could potentially lead to a better determination of what constitutes unresectability, as well as the frequency of recurrence.
  
  

Pancreatic cancer is the eighth most common malignancy, and the fifth leading cause of cancer-related death, in the United States. Unfortunately, patients often present late in the course of the disease. Accordingly, the 1- year survival rate is approximately 20%, and the 5-year survival rate is less than 4%. Even in patients with local disease who are surgical candidates, survival at five years remains only 10-25%. Staging for pancreatic adenocarcinoma typically utilizes the TNM classification, where "T" represents tumor size, "N" represents regional lymph node metastasis, and "M" represents distant metastasis. This type of staging can usually only be done after operative resection. Unfortunately, up to 25% of patients are found to be unresectable at the time of surgical exploration. This is most often due to local invasion or metastatic disease. Local microscopic invasion is associated with recurrence of pancreatic cancer after pancreatic resection. Comprehensive data on the patterns of local invasion by pancreatic cancer have not been published. We believe that it would be beneficial to investigate the frequency of the various methods of local invasion of pancreatic adenocarcinoma. A clearer understanding of the natural history of local invasion could potentially lead to a better determination of what constitutes unresectability.