Impact of different surgical approaches on prognosis in patients with pancreatic neck cancer: A retrospective cohort study

doi:10.5306/wjco.124078

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World Journal of Clinical Oncology

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2218-4333

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Baishideng Publishing Group Inc, 7041 Koll Center Parkway, Suite 160, Pleasanton, CA 94566, USA

Retrospective Cohort Study

Copyright: ©Author(s) 2026. This article is an open access article distributed under the terms and conditions of the Creative Commons Attribution-NonCommercial (CC BY-NC 4.0) license. No commercial re-use. See permissions. Published by Baishideng Publishing Group Inc.

World J Clin Oncol. Oct 24, 2026; 17(10): 124078
Published online Oct 24, 2026. doi: 10.5306/wjco.124078

Impact of different surgical approaches on prognosis in patients with pancreatic neck cancer: A retrospective cohort study

Ming-Jian Ma, He Cheng, Yu-Sheng Chen, Xian-Jun Yu, Chen Liu

Ming-Jian Ma, He Cheng, Yu-Sheng Chen, Xian-Jun Yu, Chen Liu, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China

Ming-Jian Ma, Yu-Sheng Chen, Chen Liu, Department of Oncology, Shanghai Medical College, Fudan University, Shanghai Pancreatic Cancer Institute, Shanghai 200000, China

Co-first authors: Ming-Jian Ma and He Cheng.

Author contributions: Ma MJ contributed to data curation, investigation, writing original draft; Cheng H contributed to methodology, resources, supervision; Chen YS contributed to formal analysis, software, validation; Liu C and Yu XJ contributed to conceptualization, funding acquisition, editing.

AI contribution statement: No artificial intelligence tools were used in the preparation of this manuscript.

Supported by The National Key Research and Development Program, “Deep Sea and Polar Region Key Technologies and Equipment”, No. 2022YFC2804800; National Natural Science Foundation of China, No. 82072693, No. 82472954, No. 82503291, and No. 82573937; and Natural Science Foundation of Shanghai, No. 25ZR1402089.

Institutional review board statement: This study protocol was approved by Ethics Committee of Fudan University Shanghai Cancer Center, Shanghai Medical College, Fudan University.

Informed consent statement: Written informed consent was waived by the Ethics Committee of Fudan University Shanghai Cancer Center because this study was retrospective in nature and all patient data were de-identified and analyzed anonymously.

Conflict-of-interest statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

STROBE statement: The authors have read the STROBE Statement-checklist of items, and the manuscript was prepared and revised according to the STROBE Statement-checklist of items.

Data sharing statement: No benefits in any form have been received or will be received from a commercial party related directly or indirectly to the subject of this article.

Corresponding author: Chen Liu, MD, PhD, Chief Physician, Department of Pancreatic Surgery, Fudan University Shanghai Cancer Center, Shanghai 200032, China. liuchen@fudanpci.org

Received: June 5, 2026
Revised: August 5, 2026
Accepted: October 9, 2026
Published online: October 24, 2026
Processing time: 139 Days and 9.4 Hours

Abstract

BACKGROUND

Pancreatic neck cancer occurs in a unique anatomic location. The optimal radical surgical approach among distal pancreatectomy (DP), pancreaticoduodenectomy (PD), and total pancreatectomy (TP) remains controversial, especially in patients without gastroduodenal artery (GDA) invasion.

AIM

To evaluate how different surgical procedures affect overall survival (OS) and disease-free survival (DFS) in pancreatic neck cancer patients without preoperative radiographic evidence of GDA invasion.

METHODS

This single-center retrospective cohort study included 174 consecutive patients with pancreatic neck cancer who underwent radical resection with curative intent at Fudan University Shanghai Cancer Center between January 2017 and January 2022. None of the patients showed preoperative radiographic signs of GDA invasion. Patients were stratified into three groups based on surgical procedure: DP, PD, or TP. Survival curves were generated using the Kaplan-Meier method and compared with the log-rank test. Cox proportional hazards regression models were employed for univariate and multivariate analyses.

RESULTS

The cohort comprised 107 patients (61.5%) in the DP group, 41 (23.6%) in the PD group, and 26 (14.9%) in the TP group. The median OS for the entire cohort was 27.3 months, and median DFS was 17.5 months. On univariate analysis, TP was associated with significantly worse survival compared to PD and DP (OS: 17.7 vs 35.1 vs 32.2 months, P = 0.014; DFS: 11.9 months vs 19.2 months vs 20.3 months, P = 0.017). Cox multivariate analysis identified T stage [hazard ratio (HR) = 1.840, 95%CI: 1.166-2.905], tumor differentiation grade (HR = 0.311, 95%CI: 0.109-0.888), and R1 resection (HR = 2.226, 95%CI: 1.258-3.938) as independent prognostic factors for OS. After adjusting for these confounders, the type of surgical procedure was not significantly associated with OS or DFS (P > 0.05).

CONCLUSION

Surgical approach is not an independent prognostic determinant in pancreatic neck cancer patients. When R0 clearance can be achieved by DP, extending resection to PD or TP does not appear to confer a survival advantage.

Keywords: Pancreatic neck cancer; Radical resection; Survival analysis; Multivariate regression; Distal pancreatectomy; Pancreaticoduodenectomy; Total pancreatectomy

Core Tip: This retrospective cohort study of 174 patients with pancreatic neck cancer without gastroduodenal artery invasion compared distal pancreatectomy (DP), pancreaticoduodenectomy (PD), and total pancreatectomy (TP). After multivariable adjustment, surgical procedure was not an independent predictor of overall or disease-free survival; T stage, tumor differentiation, and R1 resection were. When R0 clearance can be achieved by DP, extending resection to PD or TP does not appear to improve survival.