Management of isolated recurrence after surgery for pancreatic adenocarcinoma

Background: Recurrence of pancreatic cancer after primary pancreatectomy occurs in the vast majority of patients. The role of surgical treatment for recurrent pancreatic cancer is not well established. Methods: Patients who underwent primary pancreatectomy with curative intent from 2000 to 2014 at a single large-volume centre were evaluated retrospectively. CT or PET was used to select patients with an isolated recurrence. The clinicopathological features and survival outcomes were compared according to treatment modalities. Results: Of the 1610 patients with pancreatic cancer who underwent resection, 1346 (83.6 per cent) were diagnosed with recurrent pancreatic cancer. Recurrence was locoregional in 366 patients (27.2 per cent), distant multifocal in 251 (18.6 per cent), distant isolated in 188 (14.0 per cent), locoregional plus distant in 153 (11.4 per cent) and peritoneal seeding in 388 (28.8 per cent). Of the 1346 patients with recurrence, 197 (14.6 per cent) had isolated recurrence; of these, 48 (24.4 per cent of all isolated recurrences; 3.6 per cent of all recurrences) underwent resection. Median survival of the 197 patients after diagnosis of isolated recurrence was 14.7months; it was longer in patients who underwent surgical resection than among those treated non-surgically (23.5 versus 12.0months; P = 0.014). Multivariable analysis showed that chemotherapy and resection for recurrence were associated with better prognosis. Median survival after recurrence was longest in the 23 patients with isolated pulmonary recurrence (33.3months). Survival after recurrence was better in patients who underwent resection of isolated recurrence in the remnant pancreas (median 28.0 versus 12.0months, P = 0.010) and lung (median 36.5 versus 9.5months; P = 0.010) than in those who did not undergo resection. Conclusion: Surgical resection may be considered an option for treatment of patients with isolated recurrent pancreatic cancer.