The investigation of prognostic factors and significance of neoadjuvant therapy for resectable pancreatic cancer

Abstract

Purpose: There are little studies on the recurrence pattern of pancreatic ductal adenocarcinoma (PDAC). The aim was to analyze the recurrence pattern after curative resection in PDAC patients according to the tumor location. Method: This study included 361 patients with PDAC who underwent curative-intent surgery between 2007 and 2014. Results: Among 361 patients, 75.1% (n = 271) had recurrence during the follow up period (median 31.9month [1.9w124.7]) and the 5-year overall survival rate was 29.4%. The first recurrence patterns were divided as local (n = 48, 13.3%), systemic (n=168, 46.5%) and combined (n = 55, 15.2%) type. According to the preoperative tumor location, patients with head and uncinate process mass had more local recurrence than those with body and tail mass (47.8% vs. 18.2%, p< 0.001). Regarding the head and uncinate mass, uncinate process mass showed higher recurrence rate around the superior mesenteric artery/vein (SMA/SMV) compared to head mass (76.7% vs. 35.6%, p = 0.001). On the other hand, head mass showed more frequent recurrence around the hepatoduodenal ligament (42.2% vs. 18.6%, p = 0.021). Conclusion: Most of the patients with pancreatic ductal adenocarcinoma succumb to the recurrence after curative resection. While systemic recurrence is beyond the hands of surgery, local recur may be prevented by meticulous surgery. With this in mind, different patterns of locoregional recurrence according to the tumor location should be of an important consideration. Therefore, customization of the extent of surgery according to the location of tumor is necessary for better local control.