Surgery for recurrent pancreatic ductal adenocarcinoma

Abstract

Objective: This study evaluates the outcome of patients who underwent surgery for recurrent pancreatic cancer.

Summary background data: Recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of pancreatic cancer patients within 2 years of a potential curative resection because, in most cases, occult (local and/or distant) micrometastases are present at the time of the initial resection.

Methods: Thirty patients were operated for recurrent pancreatic cancer between October 2001 and April 2005. Median time between the initial resection and recurrence was 12.0 months. While 15 patients were resected, 15 patients either underwent palliative bypass or only exploration. Prospectively recorded data were analyzed retrospectively. Survival analysis was performed using Kaplan-Meier estimation and log-rank test.

Results: The overall median survival of patients with recurrent disease was 29.0 months. After the first reresection/exploration for recurrent disease, the median survival was 11.4 months. There was a tendency of increased median survival in the group of patients undergoing resection (17.0 months) compared with the bypass/exploration group (9.4 months), although this difference was not significant (P = 0.084). In addition, patients with a prolonged interval (>9 months) from resection to recurrence were more likely to benefit from reresection compared with patients with recurrence within 9 months (median survival 17.0 vs. 7.4 months; P = 0.004). The in-hospital morbidity and mortality rate of resected patients was 20% and 6.7% compared with 13.3% and 0% of patients who underwent only exploration/palliative bypass.

Conclusion: Resection for recurrent pancreatic cancer can be carried out safely. Further studies are required to address the question whether a subgroup of patients might actually benefit from this procedure.

FIGURE 1. Median survival and actuarial 2-, 3-, 4-, and 5-year survival rate after primary tumor resection of 29 patients with pancreatic ductal adenocarcinoma (in 1 patient, the exact date of the primary operation was not known). Median survival of 30 patients matched for age, stage, and type of operation that did not undergo exploration for recurrent disease. Patients alive at follow-up or lost to follow-up were censored (∣).

FIGURE 2. Median survival and actuarial 1- and 2-year survival rate after the first operation for recurrent cancer of 30 patients with pancreatic ductal adenocarcinoma. Patients alive at follow-up or lost to follow-up were censored (∣).

FIGURE 3. Median survival for of 30 pancreatic ductal adenocarcinoma patients after the first operation for recurrent cancer: R0/R1/R2 resection versus exploration/bypass. Inset: CA 19-9 levels (in U/mL) in the indicated groups (horizontal lines median values). Patients alive at follow-up or lost to follow-up were censored (∣).

FIGURE 4. Median survival of 30 pancreatic ductal adenocarcinoma patients after the first operation for recurrent cancer with a disease-free interval of more than 9 months and less than 9 months. Patients alive at follow-up or lost to follow-up were censored (∣).