An elevated serum CA 19-9 in patients with pancreatic adenocarcinoma (PA) has been associated with a poor prognosis. This study was conducted to assess the outcome of patients with resectable pancreatic head adenocarcinoma associated with high serum CA 19-9 levels. Methods: From 2000-2007, 344 patients underwent pancreaticoduodenectomy for resectable PA. Standard preoperative staging included dual-phase helical CT scanning +/- endoscopic ultrasound. Fifty-three patients (elevated group) had preoperatively elevated serum CA 19-9 levels (>400 IU/ml) after correction for 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). Patients with a serum bilirubin of > 2 mg/dL at the time of serum CA 19-9 measurement were excluded. Serum CA 19-9 levels were re-measured after surgery and before adjuvant treatment. Fifty patients with normal preoperative serum CA 19-9 levels (<37 IU/ml) comprised the control group. Results: Both median survival (22 mos, vs. 15 mos, p= 0.02) and overall 3-year survival (32% vs. 14%, p= 0.03) were significantly longer in the control group (n= 50) compared to the elevated group (n= 53). There was no significant differences in the median survival or overall 3-year survival rates between patients with HL and VHL. Seven patients in the elevated group (4 HL and 3 VHL) are still alive after a mean follow-up of 34 months. Patients in the elevated group who normalized their serum CA 19-9 levels after resection (n= 11) had a survival equivalent to patients in the control group. Conclusions: Patients with resectable PA and high preoperative serum CA 19-9 levels have equivalent perioperative morbidity and mortality but a shorter survival compared to patients with normal preoperative serum CA 19-9 levels. Patients who normalized their serum CA 19-9 levels after resection, however, had equivalent survival to patients with normal pre-operative serum CA 19-9 levels. Pre-operative serum CA 19-9 level, by itself, should not preclude resection in patients who have undergone careful preoperative staging.

Group	n	age (yr)	† CA 19-9 (IU/ml)*	T (cm)	R0 (%)	N1 (%)	Morbidity (%)	Mortality
Control	50	64.4	33.5	2.8	41 (82)	29 (58)	18 (36)	0
Elevated	53	65.9	1756	3.1	40 (76)	39 (73)	15 (28)	0

(^†preoperative value; T: tumor size; N1: positives lymph nodes; ^*p <0.05 control vs elevated groups)