title: Follow-up after curative surgery for pancreatic ductal adenocarcinoma: asymptomatic recurrence is associated with improved survival.
abstract: OBJECTIVE
  There is no consensus on the optimal follow-up schedule of patients after surgery for pancreatic cancer. In this retrospective study, recurrence and survival were investigated for patients presenting with either symptomatic or asymptomatic recurrence. Patient, tumor and treatment characteristics that predicted the length of postrecurrence survival were identified.
  
  
  METHODS
  Clinical records of 164 patients who underwent a pancreatic resection (R0/R1) for pancreatic ductal adenocarcinoma from January 2000 to December 2010 were retrieved. Patients underwent a systematic follow-up program. Patient, tumor and treatment characteristics were compared between patients with asymptomatic and symptomatic recurrence.
  
  
  RESULTS
  Of 164 consecutive patients, 144 patients (88%) had recurrence (29 asymptomatic, 115 symptomatic). The most frequent reported symptoms were abdominal pain, fatigue/weakness, back pain, weight loss, nausea/loss of appetite and jaundice. Median time to recurrence was 12.0 months for asymptomatic and 7.0 months for symptomatic patients (P = 0.036). Median postrecurrence survival was 10.0 months for asymptomatic and 4.0 months for symptomatic patients (P < 0.0001). Median overall survival was 24.5 months for asymptomatic and 11.0 months for symptomatic patients (P < 0.0001). Symptomatic recurrence, disease free survival <12 months, and no adjuvant chemotherapy were the only independent predictors of poor postrecurrence survival. 72% of asymptomatic and 37% of symptomatic patients received oncological treatment.
  
  
  CONCLUSIONS
  Patients with asymptomatic pancreatic cancer recurrence have improved recurrence-free, postrecurrence and overall survival. Symptoms when recurrence is diagnosed are a good surrogate marker of biological aggressiveness. Detection of asymptomatic recurrence may facilitate patient eligibility for investigational studies or other forms of treatment.
authors.affiliation: Department for Hepato-Pancreato-Biliary Surgery, Division of Cancer Medicine, Surgery and Transplantation, Oslo University Hospital, Sognsvannsveien 20, Oslo, Norway.
authors.forename: T
authors.initials: T
authors.lastname: Nordby
authors.forename: H
authors.initials: H
authors.lastname: Hugenschmidt
authors.forename: M W
authors.initials: MW
authors.lastname: Fagerland
authors.forename: T
authors.initials: T
authors.lastname: Ikdahl
authors.forename: T
authors.initials: T
authors.lastname: Buanes
authors.forename: K J
authors.initials: KJ
authors.lastname: Labori
mesh_terms: D015746:Abdominal Pain / Q000209:etiology; D000328:Adult; D000368:Aged; D000369:Aged, 80 and over; D000704:Analysis of Variance; D001416:Back Pain / Q000209:etiology; D021441:Carcinoma, Pancreatic Ductal / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D017024:Chemotherapy, Adjuvant; D015986:Confounding Factors, Epidemiologic; D018572:Disease-Free Survival; D005221:Fatigue / Q000209:etiology; D005260:Female; D005500:Follow-Up Studies; D006801:Humans; D007565:Jaundice / Q000209:etiology; D053208:Kaplan-Meier Estimate; D008207:Lymphatic Metastasis; D008297:Male; D008499:Medical Records; D008875:Middle Aged; D009325:Nausea / Q000209:etiology; D060787:Neoplasm Grading; D009367:Neoplasm Staging; D010180:Pancreatectomy / Q000379:methods*; D010190:Pancreatic Neoplasms / Q000150:complications / Q000401:mortality* / Q000473:pathology / Q000601:surgery* / Q000628:therapy; D016577:Pancreaticoduodenectomy / Q000379:methods; D011159:Population Surveillance / Q000379:methods; D011379:Prognosis; D018714:Radiotherapy, Adjuvant; D012008:Recurrence; D012189:Retrospective Studies; D013156:Splenectomy; D014057:Tomography, X-Ray Computed; D015431:Weight Loss