Vincent P Groot1, Lois A Daamen1, Jeroen Hagendoorn1, Inne H M Borel Rinkes1, Hjalmar C van Santvoort2, I Quintus Molenaar3. 1. Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands. 2. Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands; Department of Surgery, St. Antonius Hospital Nieuwegein, Nieuwegein, The Netherlands. 3. Department of Surgery, UMC Utrecht Cancer Center University Medical Center Utrecht, Utrecht, The Netherlands. Electronic address: i.q.molenaar@umcutrecht.nl.
Abstract
BACKGROUND: Controversy exists whether follow-up after resection of pancreatic ductal adenocarcinoma (PDAC) should include standardized imaging for the detection of disease recurrence. The purpose of this study was to evaluate how often patients undergo imaging in a setting where routine imaging is not performed. Secondly, the pattern, timing, and treatment of recurrent PDAC were assessed. MATERIALS AND METHODS: This was a post hoc analysis of a prospective database of all consecutive patients undergoing pancreatic resection of PDAC between January 2011 and January 2015. Data on imaging procedures during follow-up, recurrence location, and treatment for recurrence were extracted and analyzed. Associations between clinical characteristics and post-recurrence survival were assessed with the log-rank test and Cox univariable and multivariable proportional hazards models. RESULTS: A total of 85 patients were included. Seventy-four patients (87%) underwent imaging procedures during follow-up at least once, with a mean amount of 3.1 ± 1.9 imaging procedures during the entire follow-up period. Sixty-eight patients (80%) were diagnosed with recurrence, 58 (85%) of whom after the manifestation of clinical symptoms. Additional tumor-specific treatment was administered in 17 of 68 patients (25%) with recurrence. Patients with isolated local recurrence, treatment after recurrence, and a recurrence-free survival >10 mo had longer post-recurrence survival. CONCLUSIONS: Even though a symptomatic follow-up strategy does not include routine imaging, the majority of patients with resected PDAC underwent additional imaging procedures during their follow-up period. Further prospective studies are needed to determine the actual clinical value, psychosocial implications, and cost-effectiveness of different forms of follow-up after resection of PDAC.
BACKGROUND: Controversy exists whether follow-up after resection of pancreatic ductal adenocarcinoma (PDAC) should include standardized imaging for the detection of disease recurrence. The purpose of this study was to evaluate how often patients undergo imaging in a setting where routine imaging is not performed. Secondly, the pattern, timing, and treatment of recurrent PDAC were assessed. MATERIALS AND METHODS: This was a post hoc analysis of a prospective database of all consecutive patients undergoing pancreatic resection of PDAC between January 2011 and January 2015. Data on imaging procedures during follow-up, recurrence location, and treatment for recurrence were extracted and analyzed. Associations between clinical characteristics and post-recurrence survival were assessed with the log-rank test and Cox univariable and multivariable proportional hazards models. RESULTS: A total of 85 patients were included. Seventy-four patients (87%) underwent imaging procedures during follow-up at least once, with a mean amount of 3.1 ± 1.9 imaging procedures during the entire follow-up period. Sixty-eight patients (80%) were diagnosed with recurrence, 58 (85%) of whom after the manifestation of clinical symptoms. Additional tumor-specific treatment was administered in 17 of 68 patients (25%) with recurrence. Patients with isolated local recurrence, treatment after recurrence, and a recurrence-free survival >10 mo had longer post-recurrence survival. CONCLUSIONS: Even though a symptomatic follow-up strategy does not include routine imaging, the majority of patients with resected PDAC underwent additional imaging procedures during their follow-up period. Further prospective studies are needed to determine the actual clinical value, psychosocial implications, and cost-effectiveness of different forms of follow-up after resection of PDAC.
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Roberto J Rivero-Soto; Jun Yu; Ammar A Javed; Richard A Burkhart; Inne H M Borel Rinkes; I Quintus Molenaar; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2018-03-23 Impact factor: 12.969
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Ding Ding; Ammar A Javed; Richard A Burkhart; Jun Yu; Inne H Borel Rinkes; I Quintus Molenaar; John L Cameron; Elliot K Fishman; Ralph H Hruban; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Oncol Date: 2018-06-14 Impact factor: 5.344
Authors: Vincent P Groot; Georgios Gemenetzis; Alex B Blair; Roberto J Rivero-Soto; Jun Yu; Ammar A Javed; Richard A Burkhart; Inne H M Borel Rinkes; I Quintus Molenaar; John L Cameron; Matthew J Weiss; Christopher L Wolfgang; Jin He Journal: Ann Surg Date: 2019-06 Impact factor: 13.787
Authors: R Casolino; C Braconi; G Malleo; S Paiella; C Bassi; M Milella; S B Dreyer; F E M Froeling; D K Chang; A V Biankin; T Golan Journal: Ann Oncol Date: 2020-11-26 Impact factor: 32.976