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김송철 한국간담췌외과학회 2005 한국간담췌외과학회지 Vol.9 No.3
Purpose: Most patients who undergo a curative resection of a pancreatic ductal adenocarcinoma (PDAC) develop recurrence, usually at the tumor bed or in the liver, which has been associated with the poor prognosis of a PDAC. In this study, the clinical characteristics of the recurrences following curative resection of a PDAC were analyzed to discover the surgical and adjuvant treatment strategies. Methods: Between May 1990 and December 2002, 156 patients diagnosed with a recurrence after curative resection of a PDAC were analyzed for the pattern of recurrence, time of recurrence, associations with stage and adjuvant therapy, and survival using a retrospective review of their medical records. Results: Local and systemic recurrences were found in 41.0 and 25.7%, respectively. About half of the recurrences occurred within 6 months of the operation. A local recurrence was found more frequently in the body and tail than in the head, which occurred earlier than a systemic recurrence at an advanced stage. A local recurrence occurred in 40% of patients treated with surgery alone, and in 29.4% of those treated with surgery plus radiotherapy, whereas a systemic recurrence occurred in 25.5% of patients treated with surgery alone, and in 17.4% of those treated with surgery plus chemotherapy. The patients with a local recurrence had asignificantly prolonged median disease free survival time (7.8 months) than those with a systemic recurrence (5.8 months). The two-year survival rate for the locally recurred patients was greater than that for those with a systemic recurrence (23.4% vs. 17.5%). Conclusion: Our study showed a high rate and early occurrence of local recurrence, with a poor survival rate within 1 year, even after curative resection of the PDAC. There is still a great need for advances in meticulous surgical techniques for the control of local recurrence, especially in body and tail lesion or an advanced stage, and new adjuvant therapeutic modalities following curative resection to improve the survival rate of patients with a PDAC. Purpose: Most patients who undergo a curative resection of a pancreatic ductal adenocarcinoma (PDAC) develop recurrence, usually at the tumor bed or in the liver, which has been associated with the poor prognosis of a PDAC. In this study, the clinical characteristics of the recurrences following curative resection of a PDAC were analyzed to discover the surgical and adjuvant treatment strategies. Methods: Between May 1990 and December 2002, 156 patients diagnosed with a recurrence after curative resection of a PDAC were analyzed for the pattern of recurrence, time of recurrence, associations with stage and adjuvant therapy, and survival using a retrospective review of their medical records. Results: Local and systemic recurrences were found in 41.0 and 25.7%, respectively. About half of the recurrences occurred within 6 months of the operation. A local recurrence was found more frequently in the body and tail than in the head, which occurred earlier than a systemic recurrence at an advanced stage. A local recurrence occurred in 40% of patients treated with surgery alone, and in 29.4% of those treated with surgery plus radiotherapy, whereas a systemic recurrence occurred in 25.5% of patients treated with surgery alone, and in 17.4% of those treated with surgery plus chemotherapy. The patients with a local recurrence had asignificantly prolonged median disease free survival time (7.8 months) than those with a systemic recurrence (5.8 months). The two-year survival rate for the locally recurred patients was greater than that for those with a systemic recurrence (23.4% vs. 17.5%). Conclusion: Our study showed a high rate and early occurrence of local recurrence, with a poor survival rate within 1 year, even after curative resection of the PDAC. There is still a great need for advances in meticulous surgical techniques for the control of local recurrence, especially in body and tail lesion or an advanced stage, and new adjuvant therapeutic modalities following curative resection to improve the survival rate of patients with a PDAC.
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