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Multicenter Study
. 2025 Jan 1;160(1):74-84.
doi: 10.1001/jamasurg.2024.5024.

Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

Paul C M Andel  1 , Iris W J M van Goor  1   2 , Simone Augustinus  3   4 , Frederik Berrevoet  5 , Marc G Besselink  3   4 , Rajesh Bhojwani  6 , Ugo Boggi  7 , Stefan A W Bouwense  8   9 , Geert A Cirkel  10 , Jacob L van Dam  11 , Angela Djanani  12 , Dimitri Dorcaratto  13 , Stephan Dreyer  14   15 , Marcel den Dulk  8   9 , Isabella Frigerio  16 , Poya Ghorbani  17 , Mara R Goetz  18 , Bas Groot Koerkamp  11 , Filip Gryspeerdt  5 , Camila Hidalgo Salinas  19 , Martijn Intven  2 , Jakob R Izbicki  18 , Rosa Jorba Martin  20 , Emanuele F Kauffmann  7 , Reinhold Klug  21 , Mike S L Liem  22 , Misha D P Luyer  23 , Manuel Maglione  24 , Elena Martin-Perez  25 , Mark Meerdink  26 , Vincent E de Meijer  26 , Vincent B Nieuwenhuijs  27 , Andrej Nikov  28 , Vitor Nunes  29 , Elizabeth Pando  30   31 , Dejan Radenkovic  32 , Geert Roeyen  33 , Francisco Sanchez-Bueno  34 , Alejandro Serrablo  35 , Ernesto Sparrelid  17 , Konstantinos Tepetes  36 , Rohan G Thakkar  37 , George N Tzimas  38 , Robert C Verdonk  39 , Meike Ten Winkel  40 , Alessandro Zerbi  41 , Vincent P Groot  1 , I Quintus Molenaar  1 , Lois A Daamen  1   42 , Hjalmar C van Santvoort  1 ; European-African Hepato-Pancreato-Biliary Association
Collaborators, Affiliations
Multicenter Study

Routine Imaging or Symptomatic Follow-Up After Resection of Pancreatic Adenocarcinoma

Paul C M Andel et al. JAMA Surg. .

Erratum in

  • Error in Author Affiliation and Name.
    [No authors listed] [No authors listed] JAMA Surg. 2025 Jan 1;160(1):115. doi: 10.1001/jamasurg.2024.6210. JAMA Surg. 2025. PMID: 39774612 No abstract available.

Abstract

Importance: International guidelines lack consistency in their recommendations regarding routine imaging in the follow-up after pancreatic resection for pancreatic ductal adenocarcinoma (PDAC). Consequently, follow-up strategies differ between centers worldwide.

Objective: To compare clinical outcomes, including recurrence-focused treatment and survival, in patients with PDAC recurrence who received symptomatic follow-up or routine imaging after pancreatic resection in international centers affiliated with the European-African Hepato-Pancreato-Biliary Association (E-AHPBA).

Design, setting, and participants: This was a prospective, international, cross-sectional study. Patients from a total of 33 E-AHPBA centers from 13 countries were included between 2020 and 2021. According to the predefined study protocol, patients who underwent PDAC resection and were diagnosed with disease recurrence were prospectively included. Patients were stratified according to postoperative follow-up strategy: symptomatic follow-up (ie, without routine imaging) or routine imaging.

Exposures: Symptomatic follow-up or routine imaging in patients who underwent PDAC resection.

Main outcomes and measures: Overall survival (OS) was estimated with Kaplan-Meier curves and compared using the log-rank test. To adjust for potential confounders, multivariable logistic regression was used to evaluate the association between follow-up strategy and recurrence-focused treatment. Multivariable Cox proportional hazard analysis was used to study the independent association between follow-up strategy and OS.

Results: Overall, 333 patients (mean [SD] age, 65 [11] years; 184 male [55%]) with PDAC recurrence were included. Median (IQR) follow-up at time of analysis 2 years after inclusion of the last patient was 40 (30-58) months. Of the total cohort, 98 patients (29%) received symptomatic follow-up, and 235 patients (71%) received routine imaging. OS was 23 months (95% CI, 19-29 months) vs 28 months (95% CI, 24-30 months) in the groups who received symptomatic follow-up vs routine imaging, respectively (P = .01). Routine imaging was associated with receiving recurrence-focused treatment (adjusted odds ratio, 2.57; 95% CI, 1.22-5.41; P = .01) and prolonged OS (adjusted hazard ratio, 0.75; 95% CI, 0.56-.99; P = .04).

Conclusion and relevance: In this international, prospective, cross-sectional study, routine follow-up imaging after pancreatic resection for PDAC was independently associated with receiving recurrence-focused treatment and prolonged OS.

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Conflict of interest statement

Conflict of Interest Disclosures: Dr Intven reported receiving personal fees from Elekta outside the submitted work. Dr de Meijer reported receiving grants from ZonMW Veni, Health~Holland PPP Allowance, and NVGE Research Grant outside the submitted work. No other disclosures were reported.

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