ORIGINAL ARTICLES
A Nationwide Analysis
Daamen, Lois A. MD∗,†; Groot, Vincent P. MD, PhD∗; Besselink, Marc G. MD, PhD‡; Bosscha, Koop MD, PhD§; Busch, Olivier R. MD, PhD‡; Cirkel, Geert A. MD, PhD¶,||; van Dam, Ronald M. MD, PhD∗∗; Festen, Sebastiaan MD, PhD††; Groot Koerkamp, Bas MD, PhD‡‡; Haj Mohammad, Nadia MD, PhD¶; van der Harst, Erwin MD, PhD§§; de Hingh, Ignace H. J. T. MD, PhD¶¶; Intven, Martijn P. W. MD, PhD†; Kazemier, Geert MD, PhD||||; Los, Maartje MD, PhD¶; Meijer, Gert J. PhD†; de Meijer, Vincent E. MD, PhD∗∗∗; Nieuwenhuijs, Vincent B. MD, PhD†††; Pranger, Bobby K. BSc∗∗∗; Raicu, Mihaela G. MD, PhD‡‡‡; Schreinemakers, Jennifer M. J. MD, PhD§§§; Stommel, Martijn W. J. MD, PhD¶¶¶; Verdonk, Robert C. MD, PhD||||||; Verkooijen, Helena M. MD, PhD∗∗∗∗; Molenaar, Izaak Quintus MD, PhD††††; van Santvoort, Hjalmar C. MD, PhD††††; for the Dutch Pancreatic Cancer Group
∗Department of Surgery, UMC Utrecht Cancer Center, Utrecht University, Utrecht, the Netherlands
†Department of Radiation Oncology, UMC Utrecht Cancer Center, Utrecht University, Utrecht, the Netherlands
‡Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, University of Amsterdam, the Netherlands
§Department of Surgery, Jeroen Bosch Hospital, Den Bosch, the Netherlands
¶Department of Medical Oncology, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands
||Department of Medical Oncology, Meander Medical Center, Amersfoort, the Netherlands
∗∗Department of Surgery, Maastricht UMC+, Maastricht, the Netherlands
††Department of Surgery, OLVG, Amsterdam, the Netherlands
‡‡Department of Surgery, Erasmus MC, Rotterdam, the Netherlands
§§Department of Surgery, Maasstad Hospital, Rotterdam, the Netherlands
¶¶Department of Surgery, Catharina Hospital, Eindhoven, the Netherlands
||||Department of Surgery, Cancer Center Amsterdam, Amsterdam UMC, Vrije Universiteit, Amsterdam, the Netherlands
∗∗∗Department of Surgery, University of Groningen, University Medical Center Groningen, Groningen, the Netherlands
†††Department of Surgery, Isala, Zwolle, the Netherlands
‡‡‡Department of Pathology, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
§§§Department of Surgery, Amphia Hospital, Breda, the Netherlands
¶¶¶Department of Surgery, Radboud University Medical Center, Nijmegen, the Netherlands
||||||Department of Gastroenterology, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, the Netherlands
∗∗∗∗Imaging Division, University Medical Centre Utrecht; Utrecht University, Utrecht, the Netherlands
††††Department of Surgery, Regional Academic Cancer Center Utrecht, UMC Utrecht Cancer Center & St. Antonius Hospital Nieuwegein, Utrecht University, the Netherlands.
[emailprotected], [emailprotected].
I. Quintus Molenaar and Hjalmar C. van Santvoort share senior authorship.
Authors’ contributions: Study conception and design: Daamen, Groot, Besselink, Bosscha, Busch, Cirkel, van Dam, Festen, Groot Koerkamp, Haj Mohammad, van der Harst, de Hingh, Intven, Kazemier, Los, Meijer, de Meijer, Nieuwenhuijs, Pranger, Raicu, Schreinemakers, Stommel, Verdonk, Verkooijen, Molenaar, van Santvoort.
Acquisition of data: Daamen, Groot, Besselink, Bosscha, van Dam, Festen, Groot Koerkamp, van der Harst, de Hingh, Kazemier, de Meijer, Nieuwenhuijs, Pranger, Schreinemakers, Stommel, Molenaar, van Santvoort.
Analysis and interpretation of data: Daamen, Groot, Besselink, Groot Koerkamp, Haj Mohammad, de Hingh, Intven, Meijer, Verkooijen, Molenaar, van Santvoort.
Drafting of manuscript: Daamen, Groot, Molenaar, van Santvoort.
Critical manuscript revision: Daamen, Groot, Besselink, Bosscha, Busch, Cirkel, van Dam, Festen, Groot Koerkamp, Haj Mohammad, van der Harst, de Hingh, Intven, Kazemier, Los, Meijer, de Meijer, Nieuwenhuijs, Pranger, Raicu, Schreinemakers, Stommel, Verdonk, Verkooijen, Molenaar, van Santvoort.
This research did not receive any specific grant from funding agencies in the public, commercial, or not-for-profit sectors.
The authors report no conflicts of interest.
Supplemental digital content is available for this article. Direct URL citations appear in the printed text and are provided in the HTML and PDF versions of this article on the journal's Web site (www.annalsofsurgery.com).
Annals of Surgery 275(4):p 769-775, April 2022. | DOI: 10.1097/SLA.0000000000004093
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Abstract
Objective:
To evaluate whether detection of recurrent pancreatic ductal adenocarcinoma (PDAC) in an early, asymptomatic stage increases the number of patients receiving additional treatment, subsequently improving survival.
Summary of Background data:
International guidelines disagree on the value of standardized postoperative surveillance for early detection and treatment of PDAC recurrence.
Methods:
A nationwide, observational cohort study was performed including all patients who underwent PDAC resection (2014–2016). Prospective baseline and perioperative data were retrieved from the Dutch Pancreatic Cancer Audit. Data on follow-up, treatment, and survival were collected retrospectively. Overall survival (OS) was evaluated using multivariable Cox regression analysis, before and after propensity-score matching, stratified for patients with symptomatic and asymptomatic recurrence.
Results:
Eight hundred thirty-six patients with a median follow-up of 37 months (interquartile range 30-48) were analyzed. Of those, 670 patients (80%) developed PDAC recurrence after a median follow-up of 10 months (interquartile range 5–17). Additional treatment was performed in 159/511 patients (31%) with symptomatic recurrence versus 77/159 (48%) asymptomatic patients (P < 0.001). After propensity-score matching on lymph node ratio, adjuvant therapy, disease-free survival, and recurrence site, additional treatment was independently associated with improved OS for both symptomatic patients [hazard ratio 0.53 (95% confidence interval 0.42–0.67); P < 0.001] and asymptomatic patients [hazard ratio 0.45 (95% confidence interval 0.29–0.70); P < 0.001].
Conclusions:
Additional treatment of PDAC recurrence was independently associated with improved OS, with asymptomatic patients having a higher probability to receive recurrence treatment. Therefore, standardized postoperative surveillance aiming to detect PDAC recurrence before the onset of symptoms has the potential to improve survival. This provides a rationale for prospective studies on standardized surveillance after PDAC resection.
