Oncologic impact of local recurrence in resected pancreatic cancer: its topographic preference in local recurrence patterns according to tumor location

Abstract

Introduction: The role of extended surgery and adjuvant therapy to control local recurrence is still controversial. Little is known about the oncologic impact of local recurrence and the pattern of recurrence according to tumor location. Methods: From July 1992 to December 2016, patients who underwent curative-intent surgery for pancreatic ductal adenocarcinoma were retrospectively reviewed. Results: 76.5% (n = 289) of the 378 patients had recurrence during the follow-up period (median 29.0 month [1.3∼139.2]). There was no recurrence in 92 (24.3%) patients. The first recurrence pattern was local in 83 (22.0%) patients, systemic in 152 (40.2%) patients, and loco-systemic in 51 (13.5%) patients. The 5-year survival rates according to recurrence pattern were 76.6% (no recurrence), 10.3% (local), 16.9% (systemic), and 11.3% (loco-systemic). Neoadjuvant chemoradiation was helpful in lowering local recurrence (24.7% vs. 16.0%, p = 0.038), but not systemic recurrence. Remnant pancreas, common hepatic artery, celiac trunk, and paraaortic area were the common sites of frequent local recurrence. However, the superior mesenteric artery (38 vs. 7, p = 0.005) and portal vein (34 vs. 2, p < 0.001) were more frequent local recurrence sites for the head tumor, and the surgical bed was the one for the body and tail tumor (1 vs. 7, p = 0.002). Conclusion: Local recurrence of pancreatic cancer has an oncologic impact similar to systemic recurrence. Because of anatomical relationship of the pancreas and the surrounding organs, there are frequent sites of local recurrence depending on the location of the tumor. Further investigation is necessary to effectively control local recurrence.