Suguru Yamada1, Akira Kobayashi2, Shoji Nakamori3, Hideo Baba4, Masakazu Yamamoto5, Hiroki Yamaue6, Tsutomu Fujii7. 1. Department of Gastroenterological Surgery (Surgery II), Nagoya University Graduate School of Medicine, Nagoya, Japan. 2. Department of Surgery, Shinshu University School of Medicine, Matsumoto, Japan. 3. Department of Hepato-Biliary-Pancreatic Surgery, National Hospital Organization Osaka National Hospital, Osaka, Japan. 4. Department of Gastroenterological Surgery, Graduate School of Medical Sciences, Kumamoto University, Kumamoto, Japan. 5. Department of Surgery, Institute of Gastroenterology, Tokyo Women's Medical University, Tokyo, Japan. 6. Second Department of Surgery, Wakayama Medical University, Wakayama, Japan. 7. Department of Surgery and Science, Graduate School of Medicine and Pharmaceutical Sciences, University of Toyama, Toyama, Japan. Electronic address: fjt@med.u-toyama.ac.jp.
Abstract
BACKGROUND: A therapeutic strategy has not been established for recurrent pancreatic cancer in the remnant pancreas. The purpose of this multicenter survey was to clarify the clinical features of remnant pancreatic cancer and to assess the appropriate operative indications. METHODS: Clinical data from 114 patients with remnant pancreatic cancer after initial pancreatectomy were collected retrospectively. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS: Variate analysis revealed that age (≥65 years), body mass index (<20 kg/m2), tumor size (≥20 mm), distance from the pancreatic stump (<10 mm), and resection of the remnant pancreatic cancer were significant prognostic factors. The median survival times of the resected (n = 90) and the nonresected group (n = 24) were 26 and 14 months, respectively (hazard ratio: 0.56; P = .012). When the patients were classified based on recurrence patterns after a second pancreatectomy, the median survival times were 30.5 months in the no recurrence group, 32.0 in the local recurrence group, and 23.0 in the distant metastasis group. A total of 8.9% of the patients had a postoperative complication of Clavien-Dindo classification III or higher, and the 90-day mortality rate was 1.1%. CONCLUSION: Resection of the remnant pancreatic cancer could offer a favorable outcome and a chance for a cure. In particular, a young and healthy patient with a relatively small tumor at least 10 mm away from the pancreatic stump appears to be the best candidate for reoperation. Furthermore, the safety profile of resection is acceptable.
BACKGROUND: A therapeutic strategy has not been established for recurrent pancreatic cancer in the remnant pancreas. The purpose of this multicenter survey was to clarify the clinical features of remnant pancreatic cancer and to assess the appropriate operative indications. METHODS: Clinical data from 114 patients with remnant pancreatic cancer after initial pancreatectomy were collected retrospectively. Clinicopathologic factors and overall survival curves were analyzed, and multivariate Cox proportional hazard models were evaluated. RESULTS: Variate analysis revealed that age (≥65 years), body mass index (<20 kg/m2), tumor size (≥20 mm), distance from the pancreatic stump (<10 mm), and resection of the remnant pancreatic cancer were significant prognostic factors. The median survival times of the resected (n = 90) and the nonresected group (n = 24) were 26 and 14 months, respectively (hazard ratio: 0.56; P = .012). When the patients were classified based on recurrence patterns after a second pancreatectomy, the median survival times were 30.5 months in the no recurrence group, 32.0 in the local recurrence group, and 23.0 in the distant metastasis group. A total of 8.9% of the patients had a postoperative complication of Clavien-Dindo classification III or higher, and the 90-day mortality rate was 1.1%. CONCLUSION: Resection of the remnant pancreatic cancer could offer a favorable outcome and a chance for a cure. In particular, a young and healthy patient with a relatively small tumor at least 10 mm away from the pancreatic stump appears to be the best candidate for reoperation. Furthermore, the safety profile of resection is acceptable.