title: Surgery for recurrence of periampullary malignancies.
abstract: OBJECTIVE
  Few studies have addressed the surgical treatment of recurrent disease after pancreatic resection. The aim of this study was to evaluate the indications, the short- and long-term outcome, and the prognostic factors impacting survival in patients undergoing a re-laparotomy for recurrence of periampullary malignancies.
  
  
  METHODS
  Between 1990 and 2007, 16 re-laparotomies were performed in 15 patients (one patient had a second re-laparotomy) with a median age of 61 years (range 31-84). Patients were identified from a prospective database and records were reviewed retrospectively.
  
  
  RESULTS
  Seven re-laparotomies were performed for a surgical emergency and nine patients had a re-laparotomy for recurrence found at imaging studies. Perioperative mortality was observed in three patients presenting with surgical emergency and a poor performance status (Eastern Cooporative Oncology Group score >or=3). Perioperative morbidity was 40%. Median survival after the first re-laparotomy for the 15 patients was 7.4 months, and was not different for patients presenting a surgical emergency versus no emergency. Patients with peritoneal carcinomatosis had a median survival of 1.4 month. In a univariate analysis of survival, a performance status of ECOG score >or=2 and a pre-operative hemoglobin level <12 g/dl were predictors of poor survival.
  
  
  CONCLUSIONS
  In selected patients, a re-laparotomy for recurrence of periampullary malignancies is feasible. Peritoneal recurrence was not a good indication for surgery. The predictors of poor survival after the re-laparotomy were a poor performance status and a low preoperative hemoglobin level.
authors.affiliation: Centre de Chirurgie Viscérale et de Transplantation-Hôpital de Hautepierre, Hôpitaux Universitaires de Strasbourg-Université Louis Pasteur, Avenue Molière, 67000, Strasbourg, France.
authors.forename: Thomas
authors.initials: T
authors.lastname: Zacharias
authors.forename: Elie
authors.initials: E
authors.lastname: Oussoultzoglou
authors.forename: Daniel
authors.initials: D
authors.lastname: Jaeck
authors.forename: Patrick
authors.initials: P
authors.lastname: Pessaux
authors.forename: Philippe
authors.initials: P
authors.lastname: Bachellier
mesh_terms: D000230:Adenocarcinoma / Q000601:surgery*; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014670:Ampulla of Vater; D003138:Common Bile Duct Neoplasms / Q000401:mortality / Q000601:surgery*; D005260:Female; D017052:Hospital Mortality; D006801:Humans; D007813:Laparotomy; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000601:surgery*; D011379:Prognosis; D012086:Reoperation; D012186:Retroperitoneal Neoplasms / Q000601:surgery; D012189:Retrospective Studies; D016019:Survival Analysis