{"status":"ok","message-type":"work","message-version":"1.0.0","message":{"indexed":{"date-parts":[[2026,10,24]],"date-time":"2026-10-24T00:28:13Z","timestamp":1792801693307,"version":"4.5.0"},"reference-count":43,"publisher":"American Medical Association (AMA)","issue":"10","content-domain":{"domain":[],"crossmark-restriction":false},"short-container-title":["JAMA Surg"],"published-print":{"date-parts":[[2024,10,1]]},"abstract":"Importance<\/jats:title>There are currently no clinically relevant criteria to predict a futile up-front pancreatectomy in patients with anatomically resectable pancreatic ductal adenocarcinoma.<\/jats:p><\/jats:sec>Objectives<\/jats:title>To develop a futility risk model using a multi-institutional database and provide unified criteria associated with a futility likelihood below a safety threshold of 20%.<\/jats:p><\/jats:sec>Design, Setting, and Participants<\/jats:title>This retrospective study took place from January 2010 through December 2021 at 5 high- or very high-volume centers in Italy. Data were analyzed during April 2024. Participants included consecutive patients undergoing up-front pancreatectomy at the participating institutions.<\/jats:p><\/jats:sec>Exposure<\/jats:title>Standard management, per existing guidelines.<\/jats:p><\/jats:sec>Main Outcomes and Measures<\/jats:title>The main outcome measure was the rate of futile pancreatectomy, defined as an operation resulting in patient death or disease recurrence within 6 months. Dichotomous criteria were constructed to maintain the futility likelihood below 20%, corresponding to the chance of not receiving postneoadjuvant resection from existing pooled data.<\/jats:p><\/jats:sec>Results<\/jats:title>This study included 1426 patients. The median age was 69 (interquartile range, 62-75) years, 759 patients were male (53.2%), and 1076 had head cancer (75.4%). The rate of adjuvant treatment receipt was 73.7%. For the model construction, the study sample was split into a derivation (n\u2009=\u2009885) and a validation cohort (n\u2009=\u2009541). The rate of futile pancreatectomy was 18.9% (19.2% in the development and 18.6% in the validation cohort). Preoperative variables associated with futile resection were American Society of Anesthesiologists class (95% CI for coefficients, 0.68-0.87), cancer antigen (CA) 19.9 serum levels (95% CI, for coefficients 0.05-0.75), and tumor size (95% CI for coefficients, 0.28-0.46). Three risk groups associated with an escalating likelihood of futile resection, worse pathological features, and worse outcomes were identified. Four discrete conditions (defined as CA 19.9 levels-adjusted-to-size criteria: tumor size less than 2 cm with CA 19.9 levels less than 1000 U\/mL; tumor size less than 3 cm with CA 19.9 levels less than 500 U\/mL; tumor size less than 4 cm with CA 19.9 levels less than 150 U\/mL; and tumor size less than 5 cm with CA 19.9 levels less than 50 U\/mL) were associated with a futility likelihood below 20%. Both disease-free survival and overall survival were significantly longer in patients fulfilling the criteria.<\/jats:p><\/jats:sec>Conclusions and relevance<\/jats:title>In this study, a preoperative model (MetroPancreas) and dichotomous criteria to determine the risk of futile pancreatectomy were developed. This might help in selecting patients for up-front resection or neoadjuvant therapy.<\/jats:p><\/jats:sec>","DOI":"10.1001\/jamasurg.2024.2485","type":"journal-article","created":{"date-parts":[[2024,7,24]],"date-time":"2024-07-24T15:36:17Z","timestamp":1721835377000},"page":"1139","source":"Crossref","is-referenced-by-count":54,"title":["Futility of Up-Front Resection for Anatomically Resectable Pancreatic Cancer"],"prefix":"10.1001","volume":"159","author":[{"given":"Stefano","family":"Crippa","sequence":"first","affiliation":[{"name":"Division of Pancreatic Surgery, Pancreas Translational and Clinical Research Center, San Raffaele Scientific Institute, Vita-Salute San Raffaele University, Milan, Italy"}],"role":[{"vocabulary":"crossref","role":"author"}]},{"given":"Giuseppe","family":"Malleo","sequence":"additional","affiliation":[{"name":"Unit of Pancreatic Surgery, Pancreas Institute, University of Verona Hospital Trust, GB Rossi Hospital, Verona, 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