To date surgical resection is the only curative treatment option for pancreatic ductal adenocarcinoma (PDAC). However, survival rates are poor. Resection margins have long been used as a surrogate to evaluate success of the surgery. Their prognostic value and biologic implications remain disputed. Data was obtained from pooled data of 17 clinical cancer registries in Germany collated by the German Cancer Registry Group of the Association of German Tumor Centers. Overall and disease-free survival (OS/DFS) after 5.997 PDAC resections with documented margin status were analyzed using Kaplan-Meier analyses. Subgroups by type of surgery and lymph node involvement were analyzed. Cox regression for OS and multivariable regression analysis for the endpoint resection margin negative/positive (R0/R1) were performed. Both the median OS (19.3 vs. 13.4 months, R0/R1, respectively) and DFS (14.2 vs. 10.9 months, R0/R1, respectively) were improved for margin negative cases (R0). These differences were also observed after stratifying for lymph node involvement or the type of surgery (pancreas head resection, left resection, or total pancreatectomy). Cox regression revealed a positive margin (R1) to be independently associated with a poor survival (hazard ratio 1.41). Tumor size, perineural invasion, and lymph node involvement were the strongest predictors of a margin-positive resection (R1) in multivariable regression analysis. In this large population-based study, margin status was an independent risk factor for OS and DFS after PDAC resection, even after controlling for confounding factors. Therefore, resection margin is not only a mediator variable between tumor biology and outcome.

To compare perioperative morbidity and mortality in patients receiving pancreatoduodenectomy or total pancreatectomy for pancreatic head adenocarcinoma using German Cancer Registry data. Anonymized pooled data were retrieved from regional cancer registries participating in the German Cancer Registry Group of the Association of German Tumor Centers. Included were patients diagnosed with pancreatic head adenocarcinoma since 2016, receiving curative intent pancreatoduodenectomy or total pancreatectomy. Patients were propensity-score matched according to age, sex, and histopathology. Primary endpoints were 30- and 90-day postoperative mortality. Secondary endpoints were administration of adjuvant chemotherapy, long-term survival, and patterns of cancer recurrence. The data were analyzed using R. In total, 756 patients per treatment group were matched for further analyses. R0-resection rate was comparable between pancreatoduodenectomy and total pancreatectomy (69.6 vs 73.4%, P = .154). The 30-day (9.5 vs 4.8%, P < .001) and 90-day postoperative mortality (18.0 vs 11.0%, P < .001) rates were significantly lower after pancreatoduodenectomy compared with total pancreatectomy. After pancreatoduodenectomy, more patients received adjuvant chemotherapy (43.6 vs 53.3%, P < .001) and time to adjuvant chemotherapy was shorter (60.1 vs 52.7 days, P = .002) compared with total pancreatectomy. Long-term overall survival was worse after total pancreatectomy (P < .001), also in patients receiving adjuvant chemotherapy (P = .019). The sites of recurrence were comparable between both groups (P = .274). The results of this study show greater perioperative morbidity and mortality after total pancreatectomy compared with pancreatoduodenectomy for pancreatic head malignancy. Also, long-term survival was worse after total pancreatectomy. These results emphasize the role of pancreatoduodenectomy as a standard surgical procedure for pancreatic head adenocarcinoma and suggest that total pancreatectomy should only be performed in selected patients.

Background: Intraductal papillary mucinous neoplasms (IPMNs) are premalignant cystic neoplasms of the pancreas (CNPs), which can progress to invasive IPMN and pancreatic cancer. The available literature has shown controversial results regarding prognosis and clinical outcomes after the resection of invasive IPMN. Aims: This study aims to characterize the oncologic outcomes and metastatic progression pattern after the resection of non-metastatic invasive IPMN. Methods: Data were obtained from 24 clinical cancer registries participating in the German Cancer Registry Group of the Society of German Tumor Centers (ADT). Patients with invasive IPMN (n = 217) as well as PDAC (n = 5794) between 2000 and 2021 were included and compared regarding oncological outcomes. Results: Invasive IPMN was significantly smaller in size (p < 0.001) and of a lower tumor grade (p < 0.001), with fewer lymph node metastases (p < 0.001), lymphangiosis (p < 0.001), and consequently a higher R0 resection rate (88 vs. 74%) compared to PDAC. Moreover, invasive IPMN was associated with fewer local (11 vs. 15%) and distant recurrences (29 vs. 46%) and metastasized more frequently in the lungs only (26% vs. 14%). Invasive IPMN was associated with a longer median OS (29 vs. 19 months) and DFS (31 vs. 15 months) compared to PDAC and stayed independently prognostic in multivariable analyses. These survival differences were most pronounced in early tumor stages. Interestingly, postoperative chemotherapy was not associated with improved overall survival in surgically resected invasive IPMN. Conclusions: Invasive IPMN is a rare pancreatic entity with increasing incidence in Germany. It is associated with favorable histopathological features at the time of resection and longer OS and DFS compared to PDAC, particularly before the locoregional spread has occurred. Invasive IPMNs are associated with lung-only metastasis. The benefit of postoperative chemotherapy after the resection of invasive IPMN remains uncertain.

Introduction: Ampullary adenocarcinomas (AMPACs) represent rare malignant neoplasms arising in the Ampulla of Vater. Due to a lack of prospective studies and heterogeneous results from retrospective analyses, the outcomes of adjuvant chemotherapy (AC) in AMPAC are unclear. Methods: Pooled, pseudonymized data were retrieved from clinical cancer registries participating in the German Cancer Registry Group of the Association of German Tumor Centers (GCRG/ADT). Patients who underwent surgical resection of AMPACs (ICD-10: C24.1) with subsequent follow-up or AC were included. Patients with 90-day postoperative mortality were excluded. The epidemiologic and histopathologic features as well as the overall survival and recurrences were compared in both groups using R statistics. Results: In total, 830 patients with AMPACs were identified, of which 184 (22.2%) received AC. The surgery + AC patients showed more advanced tumor stages and more pronounced locoregional invasion as compared to the group undergoing surgery alone. AC was independently associated with an improved overall survival (OS) in a multivariable analysis (HR 0.57, p < 0.001), where pT3-4 status, lymph node metastases, vascular invasion, and advanced grading remained independent prognostic factors for OS. In the subgroup analyses, AC was associated with improved OS in the patients with pT3-4 tumors, lymph node metastases, lymphovascular invasion, and advanced grading, or UICC stage III, whereas no association with the OS was observed in the other subgroups. AC was also associated with superior disease-free survival (DFS) in a multivariable analysis. Conclusions: We provide a large-scale population-based analysis of AMPAC patients, showing an association of AC with improved OS in patients with advanced-staged disease or signs of locoregional invasion as compared to surgery alone.

Background: Demographic change is leading to an increasing portion of octogenarians with pancreatic ductal adenocarcinoma (PDAC). Surgery remains a central component of curative-intent treatment. Nevertheless, it carries a risk of potentially life-threatening complications and high morbidity. Whether octogenarians benefit from surgery remains unclear. Methods: Using data from the clinical cancer registries of the 10th National Oncology Quality Conference of the ADT, we divided all patients with PDAC diagnosed between 2015 and 2023 into three age groups (≤65 years, n = 944; 66–79 years, n = 1535; ≥80 years, n = 537) and compared demographics, histopathology, treatment patterns, and survival data. Results: We observed an increasing proportion of octogenarians over the years from 15% in 2015 to 32% in 2023. While they were diagnosed with more favorable tumor stages, they more often received palliative chemotherapy (28% vs. 18%/19% in the younger cohorts). Only 24% of octogenarians who underwent surgery received adjuvant chemotherapy. Octogenarians had a worse overall and disease-free survival and 90-day mortality than the younger age groups. Furthermore, octogenarians with surgery or chemotherapy with curative intent alone had survival rates comparable to patients with palliative care. Conclusions: Octogenarians largely do not benefit from surgery alone. As only a quarter of octogenarians received adjuvant chemotherapy after surgery, neoadjuvant concepts might be useful for selecting patients who are fit enough to undergo and benefit from multimodal treatment.

Background: Colloid carcinoma (CC) is a rare subtype of pancreatic ductal adenocarcinoma (PDAC) characterized by mucin pools in over 80% of the tumor. This study compares the histopathology and outcomes of CC and not-otherwise specified PDAC (PDAC-NOS, referring to “classical” PDAC) using pooled data retrieved from regional cancer registries participating in the Clinical Cancer Registry Group of the Association of German Tumor Centers (GCRG/ADT). Materials and methods: Data from patients within the pooled dataset of the GCRG/ADT with pancreatic cancer (diagnosed between 2000 and 2023) were analyzed. Histological subtypes were identified by ICD-O3 histology code. Epidemiology, histopathology and survival rates were compared between surgically resected CC and PDAC-NOS. Prognostic impacts were assessed using uni- and multivariable regression analyses in R. Results: The study included 474 CC and 21,360 PDAC-NOS patients. CC patients presented more often without lymph node metastases (pN0: 44.0 vs. 31.5%, p < 0.001), lower grading and less lymphatic and blood vessel invasion (each p < 0.001). The R0 resection rate was similar in both groups. CC patients had superior OS compared to PDAC-NOS (median OS: 24.8 vs. 17.3 months, p < 0.001). Importantly, CC histology was an independent positive prognostic factor for OS. Grading, lymph- and blood-vessel invasion were independent prognostic factors for CC patients. Adjuvant therapy was associated with improved survival in UICC IIB CC patients. Conclusion: CC patients showed better oncological outcomes after surgical resection compared to PDAC-NOS. Thereby, CC-subtype is an independent positive prognostic factor for OS, associated with lower tumor stages, fewer lymph node metastases, and less vascular invasion.