Long-term oncologic outcomes and prognostic factors in resected stage IA pancreatic cancer: a retrospective cohort study

Abstract

Background: Stage IA pancreatic ductal adenocarcinoma (PDAC) is an early-stage disease where curative resection is feasible. While minimally invasive surgery (MIS) is increasingly used and adjuvant chemotherapy is standard for resected PDAC, their roles in stage IA patients remain unclear. This study evaluated the oncologic and perioperative outcomes of surgical approach and adjuvant chemotherapy in stage IA PDAC patients. Methods: We retrospectively analyzed patients with histologically confirmed stage IA PDAC who underwent curative-intent pancreaticoduodenectomy (PD) or distal pancreatectomy (DP) at Severance Hospital (2005-2022). Those receiving neoadjuvant therapy or other procedures were excluded. Survival was assessed with Kaplan-Meier estimates and Cox models. Results: Among 102 patients, 48 (47.1%) underwent MIS and 78 (76.5%) received adjuvant chemotherapy. The mean tumor size was 1.62 cm; 49 patients had right-sided tumors and 53 had left-sided tumors. MIS was more common in the DP group than the PD group (67.9 vs. 24.5%, p < 0.001). 12 patients (11.8%) had pathologic margin involvement of the tumor in final pathology. 59 patients (57.8%) experienced complications postoperatively and 78 patients (76.5%) received adjuvant chemotherapy. The 5-year overall and disease-free survival rates were 58.2% and 48.6%, respectively. On multivariable analysis, age (HR 1.05, p = 0.027), female sex (HR 0.32, p = 0.006), and adjuvant chemotherapy (HR 0.24, p = 0.001) were independently associated with overall survival. Age and adjuvant chemotherapy were also independently associated with recurrence-free survival. Conclusion: Adjuvant chemotherapy was associated with improved outcomes in stage IA PDAC overall, but did not confer an overall survival benefit in left-sided tumors, underscoring the need for larger studies to define its role in this subgroup.