Second-look operation for unresectable pancreatic ductal adenocarcinoma at a high-volume center.
BACKGROUND
The value of re-exploration for pancreatic ductal adenocarcinoma after the initial diagnosis of unresectability is unclear.


METHODS
In this study, we analyzed 33 patients who were re-explored after an initial diagnosis of unresectability.


RESULTS
At the time of reoperation, a resectable tumor was found in 18 patients: therefore, 15 pancreaticoduodenectomies, two total pancreatectomies and one left resection were performed with three vascular resections. Morbidity and mortality rates for the cohort were 6/33 and 1/33, without significant differences between resectable and nonresectable patients. Length of stay, duration of operation, and blood loss were significantly increased in the resection group. Kaplan-Meier survival analysis demonstrated increased median survival for resected patients (1078 days after the initial operation versus 547 days in the group of unresectable patients; p = 0.018). Analysis of the reasons against initial resection showed that, if the patients had been sent to a tertiary referral center for pancreatic surgery, a different decision in favor of resection would probably have been made in 14 out of 33 patients. A review of 10 published reports on reoperation for pancreatic cancer revealed results comparable to our study in terms of low morbidity and mortality as well as a survival benefit.


CONCLUSIONS
Reoperation for pancreatic ductal adenocarcinoma that is initially deemed unresectable can be safely performed in a selected group of patients by experienced surgeons, supporting the concept of patient centralization in pancreatic surgery. Resection at the second operation may confer a survival benefit even when the initial findings preclude a potentially curative approach.
Michalski
Christoph W
CW
Department of General Surgery, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
Kleeff
Jörg
J
Bachmann
Jeannine
J
Alkhatib
Jaber
J
Erkan
Mert
M
Esposito
Irene
I
Hinz
Ulf
U
Friess
Helmut
H
Büchler
Markus W
MW
D000230:Adenocarcinoma / Q000473:pathology / Q000601:surgery*; D000328:Adult; D000368:Aged; D021441:Carcinoma, Pancreatic Ductal / Q000473:pathology / Q000601:surgery*; D018572:Disease-Free Survival; D005260:Female; D006801:Humans; D008297:Male; D008875:Middle Aged; D010180:Pancreatectomy; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D016577:Pancreaticoduodenectomy; D011446:Prospective Studies; D012086:Reoperation; D012189:Retrospective Studies; D024162:Second-Look Surgery; D015996:Survival Rate