Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile?
BACKGROUND
The clinical implications of repeat completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas after initial pancreatectomy have not been clarified. We retrospectively analyzed our patients and evaluated the clinical implications of repeat pancreatectomy for isolated local recurrence in the remnant pancreas after initial resection for pancreatic cancer.


METHODS
One-hundred seventy patients who had recurrence of pancreatic cancer out of 326 patients who had initially undergone resection for pancreatic cancer were included in this study. Sixty-seven of 170 recurrent patients were diagnosed as having isolated local recurrence of pancreatic cancer. Eleven of these 67 patients with isolated local recurrence only in the remnant pancreas underwent repeat pancreatectomy. Characteristics and operative outcomes for these 11 patients with repeat pancreatectomy were analyzed and evaluated in comparison with other recurrent patients.


RESULTS
Among 170 patients with recurrence after initial resection for pancreatic cancer, the median survival time was 78.2 and 20.3 months after initial resection, in the repeat pancreatectomy group and the unresectable group, respectively (P < .001), and the 2- and 5-year survival probability rates after initial resection were 91%, and 82% vs 42%, and 13%, respectively. Among 67 patients with isolated local recurrence, the median survival time after repeat resection or diagnosis of recurrence was 25.0 and 9.3 months, and the 2- and 5-year survival probability rates after repeat resection or diagnosis of recurrence were and 61% and 46% vs 19% and 6.2% in the repeat pancreatectomy group and the unresectable group, respectively (P < .01). There was no difference in survivals between the unresectable isolated local recurrence group and the unresectable nonlocal recurrence group.


CONCLUSIONS
Repeat pancreatectomy might bring about beneficial effects on prognosis in selected patients with isolated local recurrence in the remnant pancreas after initial pancreatectomy for pancreatic cancer without increased operative morbidity or mortality.
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan. Electronic address: masaru@faculty.chiba-u.jp.
Masaru
M
Miyazaki
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Hideyuki
H
Yoshitomi
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Hiroaki
H
Shimizu
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Masayuki
M
Ohtsuka
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Hiroyuki
H
Yoshidome
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Katsunori
K
Furukawa
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Tsukasa
T
Takayasiki
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Satoshi
S
Kuboki
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Daiki
D
Okamura
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Daisuke
D
Suzuki
Department of General Surgery, Graduate School of Medicine, Chiba University, Chiba, Japan.
Masayuki
M
Nakajima
D000368:Aged; D000369:Aged, 80 and over; D021441:Carcinoma, Pancreatic Ductal / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D005260:Female; D006801:Humans; D007564:Japan / Q000453:epidemiology; D008297:Male; D008875:Middle Aged; D009364:Neoplasm Recurrence, Local / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D010179:Pancreas / Q000473:pathology; D010180:Pancreatectomy / Q000706:statistics & numerical data; D010190:Pancreatic Neoplasms / Q000401:mortality / Q000473:pathology / Q000601:surgery*; D012189:Retrospective Studies