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01.03.2013 | Pancreatic Tumors | Ausgabe 3/2013

Annals of Surgical Oncology 3/2013

Re-resection for Isolated Local Recurrence of Pancreatic Cancer is Feasible, Safe, and Associated with Encouraging Survival

Zeitschrift:
Annals of Surgical Oncology > Ausgabe 3/2013
Autoren:
MD Oliver Strobel, MD Werner Hartwig, MD Thilo Hackert, MSc Ulf Hinz, Viktoria Berens, MD Lars Grenacher, MD Frank Bergmann, MD Jürgen Debus, MD Dirk Jäger, MD Markus Büchler, MD Jens Werner

Abstract

Background

Local recurrence of pancreatic cancer occurs in 80 % of patients within 2 years after potentially curative resections. Around 30 % of patients have isolated local recurrence (ILR) without evidence of metastases. In spite of localized disease these patients usually only receive palliative chemotherapy and have a short survival.

Purpose

To evaluate the outcome of surgery as part of a multimodal treatment for ILR of pancreatic cancer.

Methods

All consecutive operations performed for suspected ILR in our institution between October 2001 and October 2009 were identified from a prospective database. Perioperative outcome, survival, and prognostic parameters were assessed.

Results

Of 97 patients with histologically proven recurrence, 57 (59 %) had ILR. In 40 (41 %) patients surgical exploration revealed metastases distant to the local recurrence. Resection was performed in 41 (72 %) patients with ILR, while 16 (28 %) ILR were locally unresectable. Morbidity and mortality were 25 and 1.8 % after resections and 10 and 0 % after explorations, respectively. Median postoperative survival was 16.4 months in ILR versus 9.4 months in metastatic disease (p < 0.0001). In ILR median survival was significantly longer after resection (26.0 months) compared with exploration without resection (10.8 months, p = 0.0104). R0 resection was achieved in 18 patients and resulted in 30.5 months median survival. Presence of metastases, incomplete resection, and high preoperative CA 19-9 serum values were associated with lesser survival.

Conclusions

Resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with favorable survival outcome. This concept warrants further evaluation in other institutions and in randomized controlled trials.

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