Pattern of Recurrence After Pancreaticoduodenectomy for Exocrine Pancreatic Cancer: Correlation with Survival

Abstract

The results of radical surgery for pancreatic cancer depend, like all other cancer surgery, on the technique used and the biology of the disease. We have analyzed the site and time of recurrence after pancreaticoduodenectomy for exocrine pancreatic cancer in 99 patients who died more than 6 months postoperatively. All patients had recurrent disease; 87 had local recurrence in the pancreatic bed and 93 had liver metasases. Local recurrence without liver metastases was found in 6 patients, and 12 had liver metastases but no local recurrence. Both the time from operation to clinically evident recurrence and the postoperative survival time were significantly longer for patients with local recurrence only. None of those with small tumors (≤2 cm) had liver metastases only and none of them was in stage I. Although not statistically significant, there was a tendency (4 in 5) for smaller, well-differentiated tumors without spread outside the pancreas to be associated with local recurrence without liver metastases. We conclude that, in retrospect, the surgical procedures used were inappropriate and inadequate. To cure these patients, a more radical operation or effective adjuvant treatment is needed.