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. 2021 Apr;12(2):474-483.
doi: 10.21037/jgo-20-433.

Late recurrences of pancreatic cancer in patients with long-term survival after pancreaticoduodenectomy

Andreas Minh Luu  1 , Orlin Belyaev  1 , Philipp Höhn  1 , Michael Praktiknjo  2 , Monika Janot  1 , Waldemar Uhl  1 , Chris Braumann  1
Affiliations

Late recurrences of pancreatic cancer in patients with long-term survival after pancreaticoduodenectomy

Andreas Minh Luu et al. J Gastrointest Oncol. 2021 Apr.

Abstract

Background: Pancreatic cancer remains a relevant clinical problem due to poor prognosis. Even after curative pancreaticoduodenectomy tumor recurrences occur in up to 80%. Risk factors for postoperative tumor recurrences have been identified before, but data on risk factors for tumor recurrences in patients with long-term-survival is scarce.

Methods: In this retrospective study consecutive long-term survival-patients (defined as at least 60 months survival) undergoing pancreaticoduodenectomy for pancreatic cancer from 2007-2014 were identified in the 2nd largest pancreatic surgery center in Germany. Clinical, pathohistological and laboratory values were analyzed to identify risk factors for tumor recurrence.

Results: Thirty-four of one-hundred-sixty-seven patients were identified as long-term-survival-patients in the study period. Of those, 10 patients (29.4%) suffered from tumor recurrence. Lymph vessel invasion was identified as an independent risk factor (P=0.031, hazard ratio 13.127, 95% confidence interval: 1.270-135.698). Median postoperative time to tumor recurrence in long-term-survival-patients was 49 months. Overall survival after diagnosis of tumor recurrence was 33 months. 80% (N=8) of the patients were asymptomatic. Half of the patients (N=5) suffered from local disease, with 40% undergoing curative tumor resection. CA 19-9 levels were significantly elevated at 57 U/mL (normal <27 U/mL).

Conclusions: Tumor recurrence in long-term-survival-patients is typically asymptomatic. Especially long-term-survival-patients with lymph vessel invasion are more likely to develop tumor recurrence. Therefore, a structured follow-up program including CT-scans and CA 19-9 surveillance must be continued in all patients undergoing pancreaticoduodenectomy even in cases of long-term-survival.

Keywords: Pancreatic cancer (PC); long-term survival; pancreatic ductal adenocarcinoma; pancreaticoduodenectomy; recurrence.

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Conflict of interest statement

Conflicts of Interest: All authors have completed the ICMJE uniform disclosure form (available at: http://dx.doi.org/10.21037/jgo-20-433). The authors have no conflicts of interest to declare.

Figures

Figure 1
Figure 1
Graph demonstrating the normal distribution of tumor recurrences of patients who underwent pancreaticoduodenectomy due to pancreatic cancer. Y-axis: normal distribution function. X-axis: postoperative months following pancreaticoduodenectomy.
Figure 2
Figure 2
Kaplan-Meier curve demonstrating overall survival of long-term survival patients with tumor recurrence.
See this image and copyright information in PMC

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