Repeated Pancreatectomy for Isolated Local Recurrence in the Remnant Pancreas Following Radical Pancreatectomy for Pancreatic Ductal Adenocarcinoma: A Pooled Analysis

Abstract

The mainstream treatment for recurrent pancreatic cancer is potent chemotherapy or chemoradiotherapy. However, recent clinical investigations have suggested a potential oncologic role of local resection of recurrent pancreatic cancer. This systemic review with a pooled analysis aimed to assess the potential role of local repeated pancreatectomy with respect to the survival outcomes for patients with recurrent pancreatic ductal adenocarcinoma (PDAC) in the remnant pancreas. The PubMed database was searched, and 15 articles reporting on repeated pancreatectomy for local recurrence of PDAC in the remnant pancreas were identified. The pooled individual data were examined for the clinical outcomes of repeated pancreatectomy for recurrent PDAC. The survival analysis was performed using the Kaplan–Meier method. In the pooled analysis, the mean time interval from initial pancreatectomy to repeated pancreatectomy was 41.3 months (standard deviation (SD), 29.09 months). Completion total pancreatectomy was most commonly performed as repeated pancreatectomy (46 patients, 92.0%), and partial pancreatic resection was performed for only 4 (10.3%) patients. Twenty (40.9%) patients received postoperative chemotherapy following repeated pancreatectomy. The median overall survival was 60 months (95% confidential interval (CI): 45.99–74.01) after repeated pancreatectomy for isolated local recurrence in the remnant pancreas. Overall survival was markedly longer considering the timing of the initial pancreatectomy for pancreatic cancer (median, 107 months (95% CI: 80.37–133.62). The time interval between the initial and subsequent repeated pancreatectomy for pancreatic cancer was not associated with long-term oncologic outcomes (p = 0.254). Repeated pancreatectomy cannot completely replace adjuvant chemotherapy but should be considered for patients with isolated local recurrent PDAC in the remnant pancreas.

Delayed local recurrence of pancreatic adenosquamous cell carcinoma after curative surgery: A case report

“…Yamada et al reported a median survival of 26 months in patients with remnant pancreatic recurrence who underwent resection [27] . Considering the long interval from initial pancreatectomy to the diagnosis of remnant pancreatic cancer, it is quite difficult to distinguish metachronous remnant pancreatic recurrence from a second primary pancreatic cancer [27] , [28] , [29] . We present a case of PASC in a patient who developed remnant pancreatic cancer 5 years after successful distal pancreatectomy.…”

Endoscopic approach in the diagnosis of high‐grade pancreatic intraepithelial neoplasia

“…The rate of recurrence in RP was only 3.9% 45 . A recent pooled analysis reported that repeated pancreatectomy cannot completely replace the role of adjuvant chemotherapy but should be considered for cases with isolated local recurrent PDAC in the RP 46 . Recently, a prospective observation report evaluated recurrences of early‐stage PDAC diagnoses, including 16 with stage 0 and 14 with stage IA.…”

“…45 A recent pooled analysis reported that repeated pancreatectomy cannot completely replace the role of adjuvant chemotherapy but should be considered for cases with isolated local recurrent PDAC in the RP. 46 Recently, a prospective observation report evaluated recurrences of early-stage PDAC diagnoses, including 16 with stage 0 and 14 with stage IA. Of these 30 cases, nine demonstrated a recurrence of PDAC after initial surgery; two had been diagnosed as stage 0 and seven as stage IA.…”

Recent Advances in Pancreatic Neoplasms

“…This Special Issue of the Journal of Clinical Medicine , entitled “Recent Advances in Pancreatic Neoplasms”, focuses on new possible strategies to treat pancreatic neoplasms, especially pancreatic adenocarcinoma (PDCA). This Special Issue contains 13 articles, 11 studies and 2 review articles, focusing on the pancreatic ductal adenocarcinoma ( n = 10), intraductal papillary mucinous neoplasm (IPMN) ( n = 1), neuroendocrine tumors ( n = 1) and secondary tumor to the pancreas ( n = 1) [ 3 , 4 , 5 , 6 , 7 , 8 , 9 , 10 , 11 , 12 , 13 , 14 , 15 ]. Seven papers [ 4 , 5 , 6 , 9 , 10 , 11 , 14 ] explored new prognostic factors potentially able to stratify patients with pancreatic cancer and different survival rates in order to select the adequate treatment.…”

“…Despite the fact that surgery for recurrent cancer is not recommended and rarely feasible, a series of patients with recurrent pancreatic cancer who underwent re-resection were increasingly reported in the English literature. Choi et al [ 15 ] from Korea, reviewed the literature to assess the role of repeated pancreatectomy for patients with recurrent pancreatic cancer in the remnant pancreas. The median overall survival was 60 months after repeated pancreatectomy for isolated local recurrence.…”