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Surgery for Recurrent Pancreatic Ductal Adenocarcinoma

Kleeff, Jörg MD*; Reiser, Carolin MD*; Hinz, Ulf MSc*; Bachmann, Jeannine MD*; Debus, Jürgen MD; Jaeger, Dirk MD; Friess, Helmut MD*; Büchler, Markus W. MD*

doi: 10.1097/01.sla.0000245845.06772.7d
Original Articles

Objective: This study evaluates the outcome of patients who underwent surgery for recurrent pancreatic cancer.

Summary Background Data: Recurrence of pancreatic ductal adenocarcinoma occurs in up to 80% of pancreatic cancer patients within 2 years of a potential curative resection because, in most cases, occult (local and/or distant) micrometastases are present at the time of the initial resection.

Methods: Thirty patients were operated for recurrent pancreatic cancer between October 2001 and April 2005. Median time between the initial resection and recurrence was 12.0 months. While 15 patients were resected, 15 patients either underwent palliative bypass or only exploration. Prospectively recorded data were analyzed retrospectively. Survival analysis was performed using Kaplan-Meier estimation and log-rank test.

Results: The overall median survival of patients with recurrent disease was 29.0 months. After the first reresection/exploration for recurrent disease, the median survival was 11.4 months. There was a tendency of increased median survival in the group of patients undergoing resection (17.0 months) compared with the bypass/exploration group (9.4 months), although this difference was not significant (P = 0.084). In addition, patients with a prolonged interval (>9 months) from resection to recurrence were more likely to benefit from reresection compared with patients with recurrence within 9 months (median survival 17.0 vs. 7.4 months; P = 0.004). The in-hospital morbidity and mortality rate of resected patients was 20% and 6.7% compared with 13.3% and 0% of patients who underwent only exploration/palliative bypass.

Conclusion: Resection for recurrent pancreatic cancer can be carried out safely. Further studies are required to address the question whether a subgroup of patients might actually benefit from this procedure.

Resection for recurrent pancreatic cancer does not seem to change the natural progression of the disease in most patients. Better diagnostic modalities and further studies will help to identify the subgroup of patients that might benefit from this approach.

From the Departments of *General Surgery, †Radio-Oncology, and ‡Oncology, National Cancer Center, University of Heidelberg, Heidelberg, Germany. Drs. Kleeff and Reiser contributed equally to this manuscript.

Reprints: Markus W. Büchler, MD, Department of General Surgery, University of Heidelberg, Im Neuenheimer Feld 110, 69120 Heidelberg, Germany. E-mail:

© 2007 Lippincott Williams & Wilkins, Inc.