Daisuke Hashimoto1,2, Kota Arima1, Shigeki Nakagawa1, Yuji Negoro3, Toshihiko Hirata4, Masahiko Hirota5, Masafumi Inomata6, Kengo Fukuzawa7, Takefumi Ohga8, Hiroshi Saeki9, Eiji Oki9, Yo-Ichi Yamashita1, Akira Chikamoto1, Hideo Baba10, Yoshihiko Maehara9. 1. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. 2. Department of Gastroenterological Surgery, Omuta Tenryo Hospital, 1-100 Tenryo, Omuta, 836-8566, Japan. 3. Department of Gastroenterology, Kochi Health Sciences Center, 2125 Ike, Kochi, 781-8555, Japan. 4. Department of Surgery, Japanese Red Cross Kumamoto Hospital, 2-1-1 Nagamine Minami, Higashi-ku, Kumamoto, 861-8520, Japan. 5. Department of Surgery, Kumamoto Regional Medical Center, 5-16-10 Honjo, Chuo-ku, Kumamoto, 860-0811, Japan. 6. Department of Gastroenterological and Pediatric Surgery, Oita University, Faculty of Medicine, 1-1-1 Idaigaoka, Hasama-machi, Oita, 879-5593, Japan. 7. Department of Surgery, Oita Red Cross Hospital, 3-2-37 Chiyo-cho, Oita, 870-0033, Japan. 8. Department of Surgery, Fukuoka Higashi Medical Center, 1-1-1 Chidori, Koga, 811-3195, Japan. 9. Department of Surgery and Science, Kyushu University Graduate School of Medical Sciences, 3-1-1 Maidashi, Higashi-ku, Fukuoka, 812-8582, Japan. 10. Department of Gastroenterological Surgery, Kumamoto University Graduate School of Medical Sciences, 1-1-1 Honjo, Chuo-ku, Kumamoto, 860-8556, Japan. hdobaba@kumamoto-u.ac.jp.
Abstract
BACKGROUND: After initial pancreatic resection, local recurrence of pancreatic cancer (PC) or new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this retrospective study was to clarify the clinical features and establish a treatment strategy for remnant PC. METHODS: A multicenter retrospective study with the Kyushu Study Group of Clinical Cancer was carried out. Clinical data from 50 patients who developed remnant PC were analyzed. RAS mutation analysis of the initial tumor and of remnant PC was performed in 17 cases. RESULTS: The initial pancreatic resections were performed for 37 invasive ductal carcinomas, and for 13 other tumors. Thirty-seven patients underwent a second pancreatectomy for remnant PC (resected group), while thirteen patients were not operated (unresected group). The median overall survival times were 42.2 months in the resected group and 12.3 months in the unresected group (HR 0.374; 95% CI 0.17-0.83). In RAS mutation analysis, 14 cases had at least 1 missense variant of KRAS, HRAS, or NRAS in the initial pancreatic tumor and/or remnant PC. The same missense variants between the initial tumor and remnant PC were discovered only in KRAS of one patient, and in HRAS of one patient. No case had completely consistent missense variants between the initial tumor and remnant PC. CONCLUSIONS: This study found that repeated pancreatectomy for remnant PC can prolong patient survival, and RAS mutation analysis indicated that many remnant PCs are developed from metachronous multifocal origins.
BACKGROUND: After initial pancreatic resection, local recurrence of pancreatic cancer (PC) or new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this retrospective study was to clarify the clinical features and establish a treatment strategy for remnant PC. METHODS: A multicenter retrospective study with the Kyushu Study Group of Clinical Cancer was carried out. Clinical data from 50 patients who developed remnant PC were analyzed. RAS mutation analysis of the initial tumor and of remnant PC was performed in 17 cases. RESULTS: The initial pancreatic resections were performed for 37 invasive ductal carcinomas, and for 13 other tumors. Thirty-seven patients underwent a second pancreatectomy for remnant PC (resected group), while thirteen patients were not operated (unresected group). The median overall survival times were 42.2 months in the resected group and 12.3 months in the unresected group (HR 0.374; 95% CI 0.17-0.83). In RAS mutation analysis, 14 cases had at least 1 missense variant of KRAS, HRAS, or NRAS in the initial pancreatic tumor and/or remnant PC. The same missense variants between the initial tumor and remnant PC were discovered only in KRAS of one patient, and in HRAS of one patient. No case had completely consistent missense variants between the initial tumor and remnant PC. CONCLUSIONS: This study found that repeated pancreatectomy for remnant PC can prolong patient survival, and RAS mutation analysis indicated that many remnant PCs are developed from metachronous multifocal origins.
Entities:
Keywords:
Complication; Local recurrence; Operation; Pancreatic cancer; RAS
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