[Clinical value of secondary surgical resection for recurrent or metastatic pancreatic cancer after initial surgery].

Objective: To investigate the clinical value of secondary surgical resection in patients with recurrent or metastatic pancreatic cancer after radical resection. Methods: A retrospective cohort study was conducted, analyzing clinical data from patients with postoperative recurrence of pancreatic cancer treated at the Department of Hepatobiliary and Pancreatic Surgery,the First Affiliated Hospital of Naval Medical University between January 2016 and June 2024. Among them, there were 202 males and 120 females, with an age (M(IQR)) of 59(13) years (range: 33 to 80 years). Based on common recurrence patterns,patients were divided into three cohorts:local recurrence,liver metastasis,and lung metastasis. The liver metastasis cohort was further stratified into two subgroups based on the number of metastatic lesions (≤2 vs.>2). Differences between different groups were compared using the Wilcoxon rank-sum test, χ² test, or Fisher's exact test, as appropriate. Kaplan-Meier analysis was used to compare overall survival (OS) and post-recurrence survival (PRS) among different recurrence patterns and between patients who underwent secondary resection versus those who did not within each subgroup. Univariate and multivariate Cox regression analyses were used to identify independent prognostic factors. Results: Regarding recurrence patterns, 102 patients had local recurrence, with 43 undergoing secondary resection; 138 had liver metastases, with 32 receiving metastasectomy; and 28 had lung metastases, with 14 receiving metastasectomy.The lung metastasis group demonstrated significantly better OS (68.3 months vs. 44.8 months; 68.3 months vs. 28.4 months) and PRS (30.9 months vs. 19.7 months; 30.9 months vs. 14.2 months) compared to the local recurrence and liver metastasis groups (all P<0.05). Secondary surgical resection significantly improved both OS and PRS in patients with local recurrence and liver metastasis (all P<0.05),but showed no significant survival benefit in lung metastasis patients (P>0.05). Multivariate Cox regression analysis revealed that initial surgical margin status,and secondary resection were independent prognostic factors for local recurrence patients. Initial pathological differentiation,metastatic site,post-recurrence systemic chemotherapy,and secondary resection were significant prognostic factors for liver and lung metastasis patients. Among liver metastasis patients,those with ≤2 metastatic lesions had significantly longer PRS than those with >2 lesions (24.0 months vs. 9.8 months, P=0.012), while the PRS of the >2 lesions group was comparable to that of the non-resection group (9.8 months vs. 11.0 months,P=0.733). Conclusions: The prognosis of patients with recurrent or metastatic pancreatic cancer is closely associated with recurrence patterns,with lung metastasis patients exhibiting significantly better outcomes than those with local recurrence or liver metastasis. Secondary surgical resection can significantly improve survival in patients with local recurrence or limited liver metastases (≤2 lesions) who achieve disease control through systemic therapy.