Very high serum CA 19-9 levels: A contraindication to pancreaticoduodenectomy?

O. Turrini, C. M. Schmidt, J. Moreno, P. Parikh, J. M. Matos, M. G. House, N. J. Zyromski, A. Nakeeb, H. A. Pitt, K. D. Lillemoe

Research output: Contribution to journalArticlepeer-review

24 Scopus citations


Aim To assess the outcome of patients with resectable pancreatic adenocarcinoma (PA) associated with high serum CA 19-9 levels. Methods From 2000 to 2007, 344 patients underwent pancreatoduodenectomy for PA. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after resolution of obstructive jaundice. Of these, 27 patients had high levels (400-899 IU/ml (HL)) and 26 patients had very high levels ≥900 IU/ml (VHL). Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group.Results Median survival of the control group (n = 50) versus elevated group (n = 53) was 22 versus 15 months (p = 0.02) and overall 3-year survival was 32% versus 14% (p = 0.03). There was no statistical difference in the median and 3-year overall survival between patients with HL and VHL. Patients in the elevated group who normalized their CA 19-9 levels after surgery (n = 11) had a survival equivalent to patients in the control group.Conclusions Patients who normalized their CA19-9 levels postoperatively had equivalent survival to patients with normal preoperative CA 19-9 levels. Preoperative serum CA 19-9 level by itself should not preclude surgery in patients who have undergone careful preoperative staging.

Original languageEnglish (US)
Pages (from-to)1791-1797
Number of pages7
JournalJournal of Gastrointestinal Surgery
Issue number10
StatePublished - Sep 1 2009


  • CA 19-9
  • Pancreatic adenocarcinoma
  • Pancreatic cancer
  • Pancreaticoduodenectomy

ASJC Scopus subject areas

  • Surgery
  • Gastroenterology


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