Futility in adenosquamous pancreatic cancer
Year: 2026
Type: article
Study design: Observational Study
Abstract: BACKGROUND: Adenosquamous carcinoma of the pancreas (ASCP) is a rare and aggressive subtype of pancreatic cancer with a dismal prognosis. Futility in ASCP has been inadequately studied. The aim is to assess the incidence of futility in ASCP cases within a European cohort. METHODS: Retrospective, multicenter European study including all consecutive patients who underwent surgery for ASCP between 2010 and 2024. INCLUSION CRITERIA: patients operated for ASCP during the study period. EXCLUSION CRITERIA: patients without a confirmed pathological diagnosis of ASCP, those who did not undergo surgery, or had extra-pancreatic disease. A pancreatectomy was considered futile if a patient died from postoperative complications within 90 days, or if cancer-related mortality or recurrence occurred within 6 months of the operation. RESULTS: 194 patients from 29 hospitals in 11 European countries were studied. Surgeries included 125 pancreaticoduodenectomies, 59 left pancreatectomies, and 10 total pancreatectomies. Major complications were observed in 25.3% of patients. Postoperative mortality was 5.7%. The rate of futility was 47.9%. Eleven patients (11,8%) died from postoperative complications, 69 patients (74,2%) had recurrence, and 13 patients (14%) died within 6 months due to cancer. In the multivariate analysis, a positive retroperitoneal margin, lymphatic invasion, and not receiving chemotherapy were associated with futility. CONCLUSIONS: The futility observed in ASCP is notably high and related to a positive retroperitoneal margin, lymphatic invasion, and not receiving adjuvant chemotherapy. Defining futile patients with an international consensus definition is crucial and has significant implications for shared decision-making and care optimization.
Authors: Jose Manuel Ramia, Celia Villodre, Dimitrios Giakoustidis, Paraskevi Chatzikomnitsa, Pietro Addeo, Philippe Bachellier, Gennaro Nappo, Alessandro Zerbi, Julie Navez, Gerardo Blanco-Fernández, Jakob Kirkegård, Juli Busquets, Bergthor Björnsson, Santiago Sánchez-Cabús, Elizabeth Pando, Sebastian Manuel Staubli, Sanjay Pandanaboyana, Daniel Aparicio-López, Harry VM Spiers, Paola Melgar, Rami Rhaiem, Maria João Amaral, Cristina Vallejo-Bernad, Bodil Andersson, Fernando Burdío, George Tzimas, Isabel Mora-Oliver, Michael Rousek, Carlos Domingo-del-Pozo, Ahmad Mahamid, Dimitrios Lytras, Evangelos D. Lolis, Rafael López-Andújar, María Sorribas, Pablo Alejandro López, Hassan Elghonemy, Bhargava Chikkala, Weiboom Lim, Anita Balakrishnan, María Villamonte Román, Cristina Ballester, Carlos Hörndler-Algárate, Mario Serradilla-Martín
Institutions: Universitat de Miguel Hernández d'Elx, Hospital General Universitario de Alicante Doctor Balmis, Instituto de Investigación Sanitaria y Biomédica de Alicante (ISABIAL), Papageorgiou General Hospital, Hôpitaux Universitaires de Strasbourg, Hôpital d'Hautepierre, Université de Strasbourg, Humanitas University, Université Libre de Bruxelles, Universidad de Extremadura, Aarhus University, Aarhus University Hospital, Bellvitge University Hospital, Linköping University, Region Östergötland, Hospital de Sant Pau, Vall d'Hebron Hospital Universitari, The Royal Free Hospital, Freeman Hospital, Hospital General San Jorge, University of Cambridge, Cambridge University Hospitals NHS Foundation Trust, Centre Hospitalier Universitaire de Reims, Unidade Local de Saúde de Coimbra, Hospital San Pedro, Lund University, Skåne University Hospital, Hospital Del Mar, Hygeia Hospital, Universitat de València, Hospital Clínico Universitario de Valencia, INCLIVA Health Research Institute, Charles University, Military University Hospital Prague, Hospital Universitario Doctor Peset, Technion – Israel Institute of Technology, Carmel Medical Center, Chania General Hospital ”St. George”, Hospital Universitari i Politècnic La Fe, Hospital Universitario Miguel Servet, Universidad de Granada, Instituto de Investigación Biosanitaria de Granada, Hospital Universitario Virgen de las Nieves
Language: English
Subfield: Oncology
Field: Medicine
Domain: Health Sciences
Open Access status: gold
Estimated APC paid: $2,990
OpenAlex ID: W7161634405
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