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01-09-2012 | Original Article

Selective Reoperation for Locally Recurrent or Metastatic Pancreatic Ductal Adenocarcinoma Following Primary Pancreatic Resection

Authors: Ryan M. Thomas, Mark J. Truty, Graciela M. Nogueras-Gonzalez, Jason B. Fleming, Jean-Nicolas Vauthey, Peter W. T. Pisters, Jeffrey E. Lee, David C. Rice, Wayne L. Hofstetter, Robert A. Wolff, Gauri R. Varadhachary, Huamin Wang, Matthew H. G. Katz

Published in: Journal of Gastrointestinal Surgery | Issue 9/2012

Abstract

Background

Resection of certain recurrent malignancies can prolong survival, but resection of recurrent pancreatic ductal adenocarcinoma is typically contraindicated because of poor outcomes.

Methods

All patients from 1992 to 2010 with recurrent pancreatic cancer after intended surgical cure were retrospectively evaluated. Clinicopathologic features were compared from patients who did and did not undergo subsequent reoperation with curative intent to identify factors associated with prolonged survival.

Results

Twenty-one of 426 patients (5 %) with recurrent pancreatic cancer underwent potentially curative reoperation for solitary local-regional (n = 7) or distant (n = 14) recurrence. The median disease-free interval after initial resection among reoperative patients was longer for those with lung or local-regional recurrence (52.4 and 41.1 months, respectively) than for those with liver recurrence (7.6 months, p = 0.006). The median interval between reoperation and second recurrence was longer in patients with lung recurrence (median not reached) than with liver or local-regional recurrence (6 and 9 months, respectively, p = 0.023). Reoperative patients with an initial disease-free interval >20 months had a longer median survival than those who did not (92.3 versus 31.3 months, respectively; p = 0.033).

Conclusion

Patients with a solitary pulmonary recurrence of pancreatic cancer after a prolonged disease-free interval should be considered for reoperation, as they are more likely to benefit from resection versus other sites of solitary recurrence.

Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, Varadhachary G, Abbruzzese JL, Crane CH, Krishnan S, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, Evans DB. Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol. 2009 Apr;16(4):836–847.PubMedCrossRef

Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H. Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA. 2007 Jan 17;297(3):267–277.PubMedCrossRef

Gastrointestinal Tumor Study Group. Cancer. 1987 Jun 15;59(12):2006–2010.

Breslin TM, Hess KR, Harbison DB, Jean ME, Cleary KR, Dackiw AP, Wolff RA, Abbruzzese JL, Janjan NA, Crane CH, Vauthey JN, Lee JE, Pisters PW, Evans DB. Neoadjuvant chemoradiotherapy for adenocarcinoma of the pancreas: treatment variables and survival duration. Ann Surg Oncol. 2001 Mar;8(2):123–132.PubMedCrossRef

Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, van Cutsem E, van Dekken H, Klinkenbijl JH, Jeekel J. Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg. 2007 Nov;246(5):734–740.PubMedCrossRef

Sperti C, Pasquali C, Piccoli A, Pedrazzoli S. Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg. 1997 Feb;21(2):195–200.PubMedCrossRef

Raut CP, Tseng JF, Sun CC, Wang H, Wolff RA, Crane CH, Hwang R, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, Evans DB. Impact of resection status on pattern of failure and survival after pancreaticoduodenectomy for pancreatic adenocarcinoma. Ann Surg. 2007 Jul;246(1):52–60.PubMedCrossRef

Scheele J, Stangl R, Altendorf-Hofmann A, Gall FP. Indicators of prognosis after hepatic resection for colorectal secondaries. Surgery. 1991 Jul;110(1):13–29.PubMed

Altendorf-Hofmann A, Scheele J. A critical review of the major indicators of prognosis after resection of hepatic metastases from colorectal carcinoma. Surg Oncol Clin N Am. 2003 Jan;12(1):165–192, xi.PubMedCrossRef

10.

Reddy S, Edil BH, Cameron JL, Pawlik TM, Herman JM, Gilson MM, Campbell KA, Schulick RD, Ahuja N, Wolfgang CL. Pancreatic resection of isolated metastases from nonpancreatic primary cancers. Ann Surg Oncol. 2008 Nov;15(11):3199–3206.PubMedCrossRef

11.

Mayo SC, de Jong MC, Pulitano C, Clary BM, Reddy SK, Gamblin TC, Celinksi SA, Kooby DA, Staley CA, Stokes JB, Chu CK, Ferrero A, Schulick RD, Choti MA, Mentha G, Strub J, Bauer TW, Adams RB, Aldrighetti L, Capussotti L, Pawlik TM. Surgical management of hepatic neuroendocrine tumor metastasis: results from an international multi-institutional analysis. Ann Surg Oncol. 2010 Dec;17(12):3129–3136.PubMedCrossRef

12.

Musunuru S, Chen H, Rajpal S, Stephani N, McDermott JC, Holen K, Rikkers LF, Weber SM. Metastatic neuroendocrine hepatic tumors: resection improves survival. Arch Surg. 2006 Oct;141(10):1000–1004; discussion 1005.PubMedCrossRef

13.

Poultsides GA, Schulick RD, Pawlik TM. Hepatic resection for colorectal metastases: the impact of surgical margin status on outcome. HPB (Oxford). 2010 Feb;12(1):43–49.CrossRef

14.

Nordlinger B, Guiguet M, Vaillant JC, Balladur P, Boudjema K, Bachellier P, Jaeck D. Surgical resection of colorectal carcinoma metastases to the liver. A prognostic scoring system to improve case selection, based on 1568 patients. Association Francaise de Chirurgie. Cancer. 1996 Apr 1;77(7):1254–1262.PubMedCrossRef

15.

Sarmiento JM, Heywood G, Rubin J, Ilstrup DM, Nagorney DM, Que FG. Surgical treatment of neuroendocrine metastases to the liver: a plea for resection to increase survival. J Am Coll Surg. 2003 Jul;197(1):29–37.PubMedCrossRef

16.

Kavolius JP, Mastorakos DP, Pavlovich C, Russo P, Burt ME, Brady MS. Resection of metastatic renal cell carcinoma. J Clin Oncol. 1998 Jun;16(6):2261–2266.PubMed

17.

Koizumi M, Sata N, Kasahara N, Morishima K, Sasanuma H, Sakuma Y, Shimizu A, Hyodo M, Yasuda Y. Remnant pancreatectomy for recurrent or metachronous pancreatic carcinoma detected by FDG-PET: two case reports. JOP. 2010;11(1):36–40.PubMed

18.

Dalla Valle R, Mancini C, Crafa P, Passalacqua R. Pancreatic carcinoma recurrence in the remnant pancreas after a pancreaticoduodenectomy. JOP. 2006;7(5):473–477.PubMed

19.

Miura F, Takada T, Amano H, Yoshida M, Isaka T, Toyota N, Wada K, Takagi K, Kato K. Repeated pancreatectomy after pancreatoduodenectomy. J Gastrointest Surg. 2007 Feb;11(2):179–186.PubMedCrossRef

20.

Lavu H, Nowcid LJ, Klinge MJ, Mahendraraj K, Grenda DR, Sauter PK, Rosato EL, Kennedy EP, Yeo CJ. Reoperative completion pancreatectomy for suspected malignant disease of the pancreas. J Surg Res. 2011 Sep;170(1):89–95.PubMedCrossRef

21.

Hwang RF, Wang H, Lara A, Gomez H, Chang T, Sieffert N, Moon Y, Ram S, Zimmerman S, Lee JH, Pisters PW, Tamm EP, Fleming JB, Abbruzzese JL, Evans DB. Development of an integrated biospecimen bank and multidisciplinary clinical database for pancreatic cancer. Ann Surg Oncol. 2008 May;15(5):1356–1366.PubMedCrossRef

22.

Evans DB, Varadhachary GR, Crane CH, Sun CC, Lee JE, Pisters PW, Vauthey JN, Wang H, Cleary KR, Staerkel GA, Charnsangavej C, Lano EA, Ho L, Lenzi R, Abbruzzese JL, Wolff RA. Preoperative gemcitabine-based chemoradiation for patients with resectable adenocarcinoma of the pancreatic head. J Clin Oncol. 2008 Jul 20;26(21):3496–3502.PubMedCrossRef

23.

Staley CA, Cleary KR, Abbruzzese JL, Lee JE, Ames FC, Fenoglio CJ, Evans DB. The need for standardized pathologic staging of pancreaticoduodenectomy specimens. Pancreas. 1996 May;12(4):373–380.PubMedCrossRef

24.

Arnaoutakis GJ, Rangachari D, Laheru DA, Iacobuzio-Donahue CA, Hruban RH, Herman JM, Edil BH, Pawlik TM, Schulick RD, Cameron JL, Meneshian A, Yang SC, Wolfgang CL. Pulmonary resection for isolated pancreatic adenocarcinoma metastasis: an analysis of outcomes and survival. J Gastrointest Surg. 2011 Sep;15(9):1611–1617.PubMedCrossRef

25.

Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D, Friess H, Buchler MW. Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg. 2007 Apr;245(4):566–572.PubMedCrossRef

26.

Blackmon SH, Shah N, Roth JA, Correa AM, Vaporciyan AA, Rice DC, Hofstetter W, Walsh GL, Benjamin R, Pollock R, Swisher SG, Mehran R. Resection of pulmonary and extrapulmonary sarcomatous metastases is associated with long-term survival. Ann Thorac Surg. 2009 Sep;88(3):877–884; discussion 884–875.PubMedCrossRef

27.

Welter S, Jacobs J, Krbek T, Krebs B, Stamatis G. Long-term survival after repeated resection of pulmonary metastases from colorectal cancer. Ann Thorac Surg. 2007 Jul;84(1):203–210.PubMedCrossRef

28.

Artinyan A, Anaya DA, McKenzie S, Ellenhorn JD, Kim J. Neoadjuvant therapy is associated with improved survival in resectable pancreatic adenocarcinoma. Cancer. 2011 May 15;117(10):2044–2049.PubMedCrossRef

Title: Selective Reoperation for Locally Recurrent or Metastatic Pancreatic Ductal Adenocarcinoma Following Primary Pancreatic Resection
Authors: Ryan M. Thomas
Mark J. Truty
Graciela M. Nogueras-Gonzalez
Jason B. Fleming
Jean-Nicolas Vauthey
Peter W. T. Pisters
Jeffrey E. Lee
David C. Rice
Wayne L. Hofstetter
Robert A. Wolff
Gauri R. Varadhachary
Huamin Wang
Matthew H. G. Katz
Publication date: 01-09-2012
Publisher: Springer-Verlag
Published in: Journal of Gastrointestinal Surgery / Issue 9/2012
Print ISSN: 1091-255X
Electronic ISSN: 1873-4626
DOI: https://doi.org/10.1007/s11605-012-1912-8

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Selective Reoperation for Locally Recurrent or Metastatic Pancreatic Ductal Adenocarcinoma Following Primary Pancreatic Resection

Abstract

Background

Methods

Results

Conclusion

Keynote webinar | Spotlight on medication adherence

Springer Medicine

Abstract

Background

Methods

Results

Conclusion

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