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Recurrence After Resection for Pancreatic Cancer: Is There a Place for Surgery?
Cosimo Sperti, Valentina Beltrame, Mario Gruppo^*, Lucia Moletta, Stefano Merigliano

3rd Surgical Clinic, Padova, Italy

Background Currently the treatment of recurrent pancreatic cancer remains a challenge for the advanced stage of the disease and the limited therapeutic role of chemotherapy and radiotherapy. Only a few studies have been published on the surgical approach for recurrent pancreatic cancer and at the time, re-resection for recurrent pancreatic ductal adenocarcinoma is typically contraindicated because of poor outcome. Methods Patients who had undergone surgical resection for pancreatic cancer from January 1998 to December 2011 were prospectively followed up for a median time of 28 months (17-108). Patients underwent , every three months for the first two years and then every six months, clinical evaluation, biochemical tumor marker assay (CA19-9), abdominal US and/or helical-CT, whole-body PET scan (from January 2004, PET/CT) one year after surgery or when clinically indicated. All patients were treated with adjuvant chemotherapy after primary resection. Indication for surgery was given in accordance with oncologists. Validation of recurrence diagnosis was made histologically. In all patients surgery was associated with preoperative and postoperative chemotherapy and/or radiotherapy. Results 193 patients who underwent surgery with curative intent for PDA in our Clinic from January 1998 to December 2011, developed a recurrent disease. There were 24 local, 26 local and liver, and 144 metastatic recurrences (101 liver, 31 peritoneum, 11 lung, 1 bone). Thirty-four patients underwent surgical treatment.: 20 resection, 14 only exploratory laparotomy (2) or surgical palliation (12) because the disease was too advanced or not technically resectable. Median overall survival (OS) in the group of patients who underwent resection was 10.5 months, better than OS in patients treated only with chemoradiotherapy or supportive therapy (respectively 6 and 3 months). (p<0.02). During the follow-up, 9 patients developed a second cancer that was successfully resected in all. Conclusion In selected patients, a re-laparotomy for recurrence of pancreatic cancer is feasible. Tumor recurrence survival was better in patients who underwent radical resection compared with patients treated with palliative surgery or chemotherapy alone. A close follow-up allowed to diagnose in 9 patients a second cancer; in some of these patients the surgery has prolonged the survival. Many efforts have to be invested in the recognition of localized recurrence in order to improve the outcome of these patients.

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