Long-term survival for patients with pancreatic carcinoma is low, even following resection. Most patients who undergo curative treatment, develop recurrence usually at the same site of resection or in the liver. Failure seals the fate of the patient. Local recurrence occurs frequently; however, it is rarely a direct cause of death. In fact, most patients die from distant metastases. From a clinical point of view, it is important to distinguish recurrence from relapse. In fact, recurrence can be recognized as the reappearance of the disease in the surgical bed, often due to inadequate surgical clearance. On the other hand, the concept of relapse should be much more related to the appearance of the disease in a distant site. Both underestimated staging of the diagnosis and the biological features of the tumor can cause relapse. Up to now, there have only been a few reviews on the incidence and pattern of failure following resection. Detailed knowledge of the recurring sites of pancreatic carcinoma and study of the factors influencing diseasefree survival are significant in developing neoadjuvant, surgical and adjuvant treatment. The aim of this review is to point out the major factors most commonly identified as determinants of both recurrence and relapse.
Claudio Bassi, Roberto Salvia, Letizia Boninsegna, Giuliano Barugola, Massimo Falconi, Rossella Bettini, Andrea Casarotto, Paolo Pederzoli