Impact of preoperative therapy on patterns of recurrence in pancreatic cancer

Abstract

Background: A theoretical advantage of preoperative therapy in pancreatic adenocarcinoma is that it facilitates the early treatment of micrometastases and reduces postoperative systemic recurrence.

Methods: Medical records of 309 consecutive patients undergoing resection of adenocarcinoma in the head of the pancreas were reviewed. Survival was calculated using the Kaplan-Meier method. Associations between preoperative therapy and patterns of recurrence were determined using chi-squared analysis.

Results: Preoperative therapy was administered to 108 patients and upfront surgery was performed in 201 patients. Preoperative therapy was associated with a significantly longer median disease-free survival of 14 months compared with 12 months in patients submitted to upfront surgery (P = 0.035). The rate of local disease as a component of first site of recurrence was significantly lower with preoperative therapy (11.3%) than with upfront surgery (22.9%) (P = 0.016). Preoperative therapy was associated with a lower rate of hepatic metastasis (21.7%) than upfront surgery (34.3%) (P = 0.026). Preoperative therapy did not affect rates of peritoneal or pulmonary metastasis.

Conclusions: Preoperative therapy for pancreatic cancer was associated with longer disease-free survival and lower rates of local and hepatic recurrences. These data support the use of preoperative therapy to reduce systemic and local failures after resection.

Figure 1

Sites of first recurrence after pancreatic resection in 272 patients, with (n = 106) and without (n = 166) preoperative therapy

Figure 2

Disease-free survival after pancreatic resection was longer in 106 patients treated with preoperative therapy than in 166 patients who underwent immediate surgery (P = 0.035)

Figure 3

Survival from the date of detection of recurrence was longest in patients with pulmonary metastases and shortest in those with peritoneal recurrence (P < 0.001)