Survival Impact After Resection for Postoperative Recurrence or Metastasis of Pancreatic Ductal Adenocarcinoma Analyzed Using a Time-Dependent Cox Regression Model.

BACKGROUND

Recently, surgical resection has been attempted for postoperative recurrence of pancreatic ductal adenocarcinoma (PDAC). This multicenter study aimed to investigate whether resection of any recurrent lesion contributes to the survival of patients with PDAC.

METHODS

This retrospective study of the Hepato-Pancreato-Biliary Scientific Network for Clinical Oncology Research Working Cohort involved patients with resectable/borderline resectable PDAC who underwent surgery between 2013 and 2019 and who subsequently developed recurrence after resection of the primary PDAC. A time-dependent Cox regression model adjusted for various patient background and clinicopathological factors was used.

RESULTS

The study cohort comprised 1527 patients; 96 underwent resection for recurrence, including hepatectomy in 12 patients, pneumonectomy in 40, and pancreatectomy in 42. Overall survival after the initial treatment of primary PDAC was significantly better in patients who underwent resection compared with those who did not (75.0 vs. 25.8 months). The time-dependent Cox regression model indicated that pneumonectomy for lung metastasis (HR = 0.12) and pancreatectomy for recurrence in the pancreatic remnant (HR = 0.20) significantly affected overall survival, whereas hepatectomy for liver metastasis was not (HR = 0.46).

CONCLUSION

Resection for postoperative recurrence of PDAC may offer survival benefits for selected patients, especially for lung metastasis and residual pancreatic recurrence.

TRIAL REGISTRATION: https://ClinicalTrials.gov identifier: UMIN000049664.