Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection.

Abstract

252 Background: Resection of recurrent disease in malignancies such as colorectal cancer has been shown to prolong survival but resection for recurrent pancreatic ductal adenocarcinoma (PDAC) is viewed as futile. We sought to identify factors that may be associated with prolonged survival following resection of recurrent PDAC. Methods: A retrospective review of a prospectively-maintained pancreatic tumor database was performed to identify all patients from 1992-2010 who developed recurrent PDAC after intended surgical cure. The group was screened for those who underwent a second operative procedure with curative intent. Clinicopathologic features were correlated with disease-free interval (DFI) and survival to identify factors that may be associated with prolonged survival in patients undergoing reoperation for PDAC. Results: Of 700 patients who underwent resection for PDAC, 426 (61%) recurred after a median of 8mo and 21 (5%) of those had a locoregional [pancreas (n=5), other (n=2)] or distant [lung (n=7), liver (n=6), brain (n=1)] recurrence that were selected for a second, potentially curative operation. Sixteen of 21 patients received chemotherapy prior to reoperation. Those selected had a single, technically resectable lesion, good performance status, and prolonged median DFI compared to patients not selected (22mo v. 8mo, p<0.01). The median DFI from initial resection to recurrence for those with lung (52mo) or locoregional (41mo) recurrence was longer than those with liver recurrence (10.5mo, p=0.03). The interval between reoperation and second recurrence in patients with lung metastasis (NR) was longer than for liver (6mo) or locoregional recurrence (7.5mo, p=0.02). Patients still alive include 4/7 of lung, 3/7 of locoregional, and 1/6 of liver recurrences with a median follow-up after reoperation of 30mo, 14mo, and 18.5mo, respectively. Conclusions: Patients who develop a solitary recurrence of PDAC in the lung after a long disease-free interval should be considered for reoperation. Those with recurrence in other sites are likely to re-recur relatively quickly after reoperation regardless of disease-free interval.