Objectives: The size of pancreatic tumors that can be diagnosed by preoperative imaging continues to decrease because advances in diagnostic imaging. Several surgical series have suggested that survival is better in tumors 20 mm or smaller (vs tumors >20 mm), but the incremental benefit of diagnosing progressively smaller tumors from 30 mm (currently, the average size of pancreatic tumor at diagnosis) to 20 mm or smaller is not known. We investigated survival and resectability as tumor size increased from 20 mm or smaller to 30 mm or larger.

Methods: This is a retrospective analysis of consecutive patients with pancreatic cancer, who underwent endoscopic ultrasound-guided fine-needle aspiration at MD Anderson Cancer Center between December 2000 and December 2001. Tumor size was based on the combination of endoscopic ultrasound and computed tomography imaging.

Results: The median (±SE) for tumors 20 mm or smaller, 21 to 25 mm, 26 to 30 mm and larger than 30 mm was 17.2 ± 8.2, 12.3 ± 4.9, 8.5 ± 3.6, and 7.6 ± 1.2 months (P = 0.021), respectively. Tumors were resectable in 10 (83%) of 12 tumors 20 mm or smaller, 8 (67%) of 12 tumors 21 to 25 mm, 5 (36%) of 14 of tumors 26 to 30 mm, and 2 (7%) of 27 tumors larger than 30 mm (P < 0.001).

Conclusions: A dramatic change in survival occurs as the size of pancreatic tumor increases from 20 mm or smaller to 30 mm or larger. To be effective, future strategies for early diagnosis of pancreatic cancer should aim at diagnosing most pancreatic cancers before they are 20 mm in size.