Clinical outcomes of completing total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy

Abstract

Background This study evaluated the clinical features of patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy. It specifically analyzed the postoperative and oncologic outcomes of patients who underwent completion total pancreatectomy to identify prognostic factors associated with 5-year survival. Methods A retrospective review was conducted on 93 patients with isolated recurrence of pancreatic ductal adenocarcinoma in the remnant pancreas after initial pancreatectomy between 2009 and 2020. Of these, 59 patients underwent completion total pancreatectomy, and 34 did not undergo completion total pancreatectomy. Clinicopathologic factors and overall survival were analyzed based on completion total pancreatectomy status. Results The 5-year overall survival after initial pancreatectomy for pancreatic ductal adenocarcinoma was 22.3% in the patients who did not undergo completion total pancreatectomy, with a median survival of 32.8 months. In contrast, patients who underwent completion total pancreatectomy exhibited a 5-year overall survival of 61.7% and a median survival of 91.2 months ( <.001). Among patients with early recurrence, those who underwent completion total pancreatectomy exhibited a median survival of 33.5 months. In contrast, patients with late recurrence showed a median survival of 104.2 months. Early recurrence after pancreatectomy was identified as a significant poor prognostic factor for survival (hazard ratio 6.684, 95% confidence interval 2.474–18.062, <.001), along with tumor size >4 cm and elevated carcinoembryonic antigen levels. Conclusion In the remnant pancreas, completion total pancreatectomy for isolated recurrence of pancreatic ductal adenocarcinoma may offer favorable oncologic outcomes in carefully selected patients—particularly patients with recurrence after 1 year, tumor size <4 cm, and stable tumor marker levels.