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Prognostic Significance of Radiological Adjacent Organ Invasion in Resectable Left-Sided Pancreatic Cancer
Takumi Kitahama1, Katsuhisa Ohgi1, Ryo Ashida1
1Division of Hepato-Biliary-Pancreatic Surgery, Shizuoka Cancer Center, Shizuoka, Japan.
Annals of Surgical Oncology
|March 13, 2026
Summary
Radiological adjacent organ invasion (RAOI) in resectable left-sided pancreatic cancer (LPC) is a negative prognostic factor. Patients with RAOI have worse survival outcomes and may require more intensive treatment.
Area of Science:
- Oncology
- Surgical Oncology
- Radiology
Background:
- Pancreatic cancer resectability is determined by vascular and adjacent organ involvement.
- Left-sided pancreatic cancer (LPC) typically involves adjacent organs but rarely major vessels.
- Assessing radiological adjacent organ invasion (RAOI) is crucial for resectable LPC prognosis.
Purpose of the Study:
- To evaluate the prognostic significance of radiological adjacent organ invasion (RAOI) in patients with resectable left-sided pancreatic cancer (LPC).
Main Methods:
- Retrospective analysis of 162 patients undergoing distal pancreatectomy for resectable LPC (2002-2020).
- RAOI defined by tumor contact with adjacent organs (stomach, adrenal gland, colon, liver) on CT scans.
- Comparison of clinicopathological factors and survival between RAOI (+) and RAOI (-) groups.
Main Results:
- The RAOI (+) group showed higher CA19-9 levels, larger tumor size, and more frequent positive peritoneal cytology.
- Overall survival was significantly worse in the RAOI (+) group (25.9 vs. 67.2 months).
- RAOI and elevated CA19-9 levels (≥37 U/mL) were independent risk factors for poor overall survival.
Conclusions:
- Radiological adjacent organ invasion is an independent negative prognostic factor in resectable LPC.
- RAOI is linked to early systemic spread and poorer survival, suggesting borderline resectable disease.
- Patients with RAOI (+) LPC may benefit from intensive multimodal treatment strategies.
