CA 19-9 Levels: What Is Their Role in the Resectability Assessment of Pancreatic Cancer?

¹Department of General Surgery, University Hospital of Ain Taya (Algiers), Algeria

²Department of General Surgery, University Hospital of Thenia (Boumerdes), Algeria

³Health Sciences University Youcef El Khatib Algiers, Algeria

⁴Department of Epidemiology- CHU Tizi Ouzou, Algeria

^*Corresponding author: Naima NaitSlimane, Department of General Surgery, University Hospital of Ain Taya (Algiers), Algeria, Email: [email protected]

Received Date: July 07, 2026

Published Date: September 18, 2026

Citation: Nait NS, et al. (2026). CA 19-9 Levels: What Is Their Role in the Resectability Assessment of Pancreatic Cancer?. Mathews J Surg. 9(2):45

Copyrights: Nait NS, et al. © (2026).

ABSTRACT

The CA19-9 is one of the most used serum markers in pancreatic cancer. The plasma concentration of CA19-9 is correlated with the size of the tumor among the patients diagnosed with pancreatic cancer. During medical intervention, examinations showed that about 25% of patients has an ineradicable tumor, even though preoperative morphological examinations (CT-scan, MRI, EUS) showed that it is resectable. Is the dosing of the CA 19-9 contributory to the assessment of the resectability of pancreatic cancer? And starting from which level of serum concentration?

Aim of the Study: Evaluating the utility of serum CA19-9 level in predicting the resectability of exocrine pancreatic cancer.

Methods: A five-year longitudinal retrospective monocentric comparative study, conducted on clinical data, preoperative imaging, bilirubin assay levels (exclusion criterion), and CA19-9 assay of 62 patients with pancreatic tumors of variable location and topography, without jaundice. The measurement of 03 tumor markers was systematically performed on all the patients. The patients were separated into 02 groups: patients resectable (group R): n= 15 versus unresectable (group NR): n=47. All pancreatic adenocarcinoma without jaundice (non-cholestatic) were included. The Wilcoxon test was applied in order to compare the quantitative variables. An assessment of sensibility and specifity was measured, then the precision of the test was verified using a ROC curve.

Results: The median age of the 02 groups is comparable (p=0.6), the sex ratio is 4. The location of the tumor is cephalic in 82%, corporeo-caudal 10%, and corporeal 8%. The median size in the 02 groups is 04 cm (Wilcoxon 0,15), however, in the group NR the number of the large size tumors is more important. The optimal CA19-9 cut-off is > 267 U, The serum level of CA 19-9 was significantly more elevated in the group NR (358 versus 165) p= 0,0004 Wilcoxon, the average rate (median) of CA19-9 preoperative plasma in patients from the group NR is 5 times superior than that of the patients with resectable tumors (P <0,01). Specificity and la sensibility were respectively evaluated at 93,3% and 66%. This study indicates that the CA 19-9 is not correlated to the extension of the tumor. The area under the ROC curve is 0,81 in favor of the good performance of the test with a Cut off of CA 19-9 at 267. The variations of the CA19-9 serum levels could have a direct connection with the resectability.

Conclusion: The levels of the CA 19-9 superior to 267UI/ml before the treatment appears to be associated with an advanced disease. The augmentation of plasma level (> 267 U/mL) of CA 19-9 could be considered as a useful parameter for unresectable pancreatic cancer. The test is useful with a discriminative yet not a determinant value.

Keywords: Serum Markers, Bilirubinemia, Resectability, CA19-9, Exocrine Pancreatic Cancer

ABBREVIATIONS

CA19-9: Carbohydrate Antigen 19-9

CT-scan: Computed Tomography Scan

EUS: Endoscopic Ultrasound

MRI: Magnetic Resonance Imaging

MTM: Multidisciplinary Team Meeting

R1: Microscopic Residues

R2: Macroscopic Residues

PPV: Positive Predictive Value

NPV: Negative Predictive Value

ROC curve: Receiver Operating Characteristic Curve

AUC: The Area Under the Curve ROC

TNM: Tumor Node Metastasis

NCCN: National Comprehensive Cancer Network