Clinical Impact of Structured Post-Operative Surveillance in Resected Pancreatic Adenocarcinoma: Results from a Retrospective Cohort Study

Abstract

<b><i>Introduction:</i></b> To this date, surgery remains the only potentially curative approach in the treatment of pancreatic cancer. To analyse the clinical impact of a structured post-operative follow-up programme, we retrospectively analysed a cohort of resected pancreatic adenocarcinoma patients treated at LMU Munich. <b><i>Methods:</i></b> Pancreatic adenocarcinoma patients who underwent resection and presented for regular follow-up visits at our centre between 2002 and 2017 were identified from two existing study cohorts. Diagnosis of recurrences was categorised by timing (within or outside a scheduled follow-up visit) and detection modality (imaging, CA 19-9 increase, or clinical deterioration) and correlated with disease-free survival and overall survival (OS). <b><i>Results:</i></b> One hundred and twenty-five patients with resected pancreatic adenocarcinoma were included in this analysis. Median OS in the whole cohort was 21.1 months. Of these 125 patients, 103 (82.4%) patients had a documented relapse. Tumour recurrences detected within a scheduled follow-up visit (<i>n</i> = 86, 83.5%) compared to recurrences becoming apparent at an unplanned visit (<i>n</i> = 17, 16.5%) were associated with a significantly improved OS (median 25.5 vs. 20.2 months, <i>p</i> = 0.019). Compared to patients with recurrence detected by clinical deterioration (<i>n</i> = 4, 3.9%), patients with recurrences detected by imaging or laboratory abnormalities (<i>n</i> = 99, 96.0%) had a longer median OS (24.8 vs. 15.1 months, <i>p</i> = 0.007). <b><i>Discussion:</i></b> A structured follow-up after pancreatic ductal adenocarcinoma resection may have an impact on patient outcome. Prospective trials are needed to evaluate the clinical impact of post-operative follow-up programmes.