title: Redo-surgery following curative resection of pancreatic carcinoma: the difference between true and suspected recurrence.
abstract: BACKGROUND
  Improving results have led to an extension of indications for re-resection of recurrent pancreatic carcinoma.
  
  
  METHODS
  Among 410 patients who received surgery for histologically proven pancreatic cancer, 17 underwent re-resection for a suspected local recurrence and were evaluated for overall survival, clinicopathological and perioperative data.
  
  
  RESULTS
  At the initial operation, resection was curative (R0/R1) in all 17 patients. Indication for re-resection was a suspected or proven recurrence of pancreatic cancer in all patients. Re-resection was possible in 5 patients. The remaining patients received a redo of the pancreaticojejunostomy or bilioenteric anastomosis (n = 2), exploration with biopsy (n = 4), and a palliative bypass (n = 6). Perioperative mortality was 6%. Median overall survival was 25 months (range 10-152 months) and 7 months following re-resection (5-29 months). In 5 of 17 patients, histology showed chronic pancreatitis (n = 4) or a benign stricture at the hepaticojejunostomy (n = 1), whereas all other patients had histologically proven recurrence. Re-resection or redo of the anastomosis was possible in 5 of 5 patients with chronic pancreatitis but only in 2 of 12 patients with true recurrence (p = 0.003).
  
  
  CONCLUSIONS
  Curative reoperation for recurrent pancreatic carcinoma is rarely feasible. Due to the potential for chronic pancreatitis or benign strictures as an underlying pathology, operable patients should be explored.
authors.affiliation: Department of General Surgery, St. Joseph Hospital, Ruhr University Bochum, Gudrunstrasse 56, Bochum, Germany. m.seelig@klinikum-bochum.de
authors.forename: Matthias H
authors.initials: MH
authors.lastname: Seelig
authors.forename: Monika
authors.initials: M
authors.lastname: Janot
authors.forename: Ansgar M
authors.initials: AM
authors.lastname: Chromik
authors.forename: Torsten
authors.initials: T
authors.lastname: Herzog
authors.forename: Orlin
authors.initials: O
authors.lastname: Belyaev
authors.forename: Dirk
authors.initials: D
authors.lastname: Weyhe
authors.forename: Kirsten
authors.initials: K
authors.lastname: Meurer
authors.forename: Andreas
authors.initials: A
authors.lastname: Meiser
authors.forename: Andrea
authors.initials: A
authors.lastname: Tannapfel
authors.forename: Waldemar
authors.initials: W
authors.lastname: Uhl
mesh_terms: D000328:Adult; D000368:Aged; D002277:Carcinoma / Q000473:pathology / Q000601:surgery*; D002985:Clinical Protocols; D005260:Female; D006801:Humans; D053208:Kaplan-Meier Estimate; D008279:Magnetic Resonance Imaging; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010190:Pancreatic Neoplasms / Q000473:pathology / Q000601:surgery*; D010193:Pancreaticojejunostomy; D011446:Prospective Studies; D012086:Reoperation; D016896:Treatment Outcome