Outcomes of remnant pancreatic resection for recurrent pancreatic cancer

Abstract

Background Although there have been reports that remnant pancreatic resection for recurrence of pancreatic cancer contributes to a prolonged favorable prognosis, its surgical indications and timing remain controversial. We examined the feasibility of remnant pancreatic resection and the characteristics of remnant pancreatic recurrence. Methods A total of 180 patients with pancreatic cancer who underwent pancreatic resection from 2004 to 2020 were enrolled in this study. Recurrence was observed in 124 of 180 cases. Of these 124 patients, 9 who underwent remnant pancreatic resection were compared with 82 who underwent chemotherapy. Results The 5-year survival rate for remnant pancreatic resection was 85.7%, significantly better than that for chemotherapy (15.8%, p<0.001). Regarding patients’ background at the primary pancreatic resection, the serum albumin level (p<0.01) and prognostic nutritional index (PNI) were high (p<0.01), and there were many T1/2 cases in the TNM classification (p<0.01) in the remnant pancreatic resection group; additionally, duration until recurrence was significantly longer (remnant pancreatic resection group, 2.116±1.100 years vs. chemotherapy group, 0.973±0.798 years). Furthermore, among the 9 cases of remnant pancreatic resection, 8 patients (the remaining patient died of other disease) sustained secondary recurrence after remnant pancreatic resection. Among these cases, patients with recurrence after 6 months of resection were women (p=0.02), with high PNI (p=0.01) and high rate of introduction of chemotherapy for the secondary recurrence (p=0.02). Conclusion Remnant pancreatic resection for recurrent pancreatic cancer could prolong the favorable prognosis in selected patients, taking into account the period until recurrence and nutritional status. Trial registration This study was approved by the research and ethics committee of Tokushima University Hospital (Approved number: 3215-3, Date of registration: October 25th, 2021).