title: Surgery for recurrent pancreatic ductal adenocarcinoma.
abstract: OBJECTIVE
  This study evaluates the outcome of patients who underwent surgery for recurrent pancreatic cancer.
  
  
  BACKGROUND
  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.
  
  
  CONCLUSIONS
  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.
authors.affiliation: Department of General Surgery, National Cancer Center, University of Heidelberg, Heidelberg, Germany.
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Carolin
authors.initials: C
authors.lastname: Reiser
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Jeannine
authors.initials: J
authors.lastname: Bachmann
authors.forename: Jürgen
authors.initials: J
authors.lastname: Debus
authors.forename: Dirk
authors.initials: D
authors.lastname: Jaeger
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000601:surgery*; D005858:Germany / Q000453:epidemiology; D017052:Hospital Mortality; D006801:Humans; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D016019:Survival Analysis