title: Second-look operation for unresectable pancreatic ductal adenocarcinoma at a high-volume center.
abstract: 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.
authors.affiliation: Department of General Surgery, Technische Universität München, Ismaningerstrasse 22, 81675, Munich, Germany.
authors.forename: Christoph W
authors.initials: CW
authors.lastname: Michalski
authors.forename: Jörg
authors.initials: J
authors.lastname: Kleeff
authors.forename: Jeannine
authors.initials: J
authors.lastname: Bachmann
authors.forename: Jaber
authors.initials: J
authors.lastname: Alkhatib
authors.forename: Mert
authors.initials: M
authors.lastname: Erkan
authors.forename: Irene
authors.initials: I
authors.lastname: Esposito
authors.forename: Ulf
authors.initials: U
authors.lastname: Hinz
authors.forename: Helmut
authors.initials: H
authors.lastname: Friess
authors.forename: Markus W
authors.initials: MW
authors.lastname: Büchler
mesh_terms: 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