title: CT diagnosis of recurrence after pancreatic cancer: is there a pattern?
abstract: OBJECTIVE
  To investigate predilection sites of recurrence of pancreatic cancer by computed tomography (CT) in follow-up after surgery.
  
  
  METHODS
  Seventy seven patients with recurrence after pancreatic cancer surgery were retrospectively identified. The operative technique, R-status, T-stage and development of tumor markers were evaluated. Two radiologists analyzed CT scans with consensus readings. Location of local recurrence, lymph node recurrence and organ metastases were noted. Surgery and progression of findings on follow-up CT were considered as reference standard.
  
  
  RESULTS
  The mean follow-up interval was 3.9 ± 1.8 mo, with a mean relapse-free interval of 12.9 ± 10.4 mo. The predominant site of recurrence was local (65%), followed by lymph node (17%), liver metastasis (11%) and peritoneal carcinosis (7%). Local recurrence emerged at the superior mesenteric artery (n = 28), the hepatic artery (n = 8), in an area defined by the surrounding vessels: celiac trunk, portal vein, inferior vena cava (n = 22), and in a space limited by the mesenteric artery, portal vein and inferior vena cava (n = 17). Lymph node recurrence occurred in the mesenteric root and left lateral to the aorta. Recurrence was confirmed by surgery (n = 22) and follow-up CT (n = 55). Tumor markers [carbohydrate antigen 19-9 (CA19-9), carcinoembryonic antigen (CEA)] increased in accordance with signs of recurrence in most cases (86% CA19-9; 79.2% CEA).
  
  
  CONCLUSIONS
  Specific changes of local and lymph node recurrence can be found in the course of the cardinal peripancreatic vessels. The superior mesenteric artery is the leading structure for recurrence.
authors: Department of Diagnostic and Interventional Radiology, University Hospital, Heidelberg 69120, Germany. tobias.heye@med.uni-heidelberg.de
authors: Tobias
authors: T
authors: Heye
authors: Nicola
authors: N
authors: Zausig
authors: Miriam
authors: M
authors: Klauss
authors: Reinhard
authors: R
authors: Singer
authors: Jens
authors: J
authors: Werner
authors: Götz Martin
authors: GM
authors: Richter
authors: Hans-Ulrich
authors: HU
authors: Kauczor
authors: Lars
authors: L
authors: Grenacher
mesh_terms: D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D014408:Biomarkers, Tumor / Q000378:metabolism; D005260:Female; D006801:Humans; D008198:Lymph Nodes / Q000473:pathology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000175:diagnosis* / Q000000981:diagnostic imaging* / Q000473:pathology / Q000601:surgery; D010190:Pancreatic Neoplasms / Q000000981:diagnostic imaging* / Q000473:pathology* / Q000517:prevention & control* / Q000601:surgery; D012008:Recurrence; D012189:Retrospective Studies; D014057:Tomography, X-Ray Computed / Q000379:methods*
chemical_list: D014408:Biomarkers, Tumor