Background Pancreatic ductal adenocarcinoma frequently recurs despite curative surgical resection. This study aims to investigate the patterns of recurrence following surgical resection of pancreatic ductal adenocarcinoma. By understanding the patterns of postoperative recurrence, more focused management strategies for advanced disease in pancreatic ductal adenocarcinoma may be developed. Methods A single-institution retrospective cohort analysis was performed on patients who underwent pancreatic ductal adenocarcinoma resection between 2011 and 2015. Clinical, operative and pathological data were analyzed. Statistical significance was defined as a p value <0.05. Results A total of 128 patients with pancreatic ductal adenocarcinoma underwent surgical resection in this study period. Recurrence was observed in 82 (64%) patients. Overall median time to recurrence was 12.1 months. The most common site of recurrence within six months after surgery was observed in the liver. Earliest recurrence was most frequently seen in the peritoneal cavity and liver, and longest time to recurrence was found in the lung. On Cox regression analysis, perineural invasion was identified as an independent predictor of shorter disease free survival. Survival also significantly differed by sites of recurrence, with the shortest survival observed in patients with peritoneal recurrence, and the longest survival observed in patients with lung recurrence. Conclusion This retrospective study demonstrates various patterns of recurrence following surgical resection of pancreatic ductal adenocarcinoma. By better understanding of recurrence patterns, disease progression can be better predicted and follow up can be tailored accordingly.
Sia Kim, Malinda Itchins, Jennifer Arena, Chris Nahm, Nick Pavlakis, Stephen Clarke, Anthony Gill, Jaswinder S Samra, Anubhav Mittal