Surveillance after pancreatic cancer surgery—does detection of recurrence at scheduled follow-up improve access to treatment and survival?
Anja Jagesten, Paulina Bereza-Carlson, Bodil AnderssonAbstract
Introduction
Pancreatic ductal adenocarcinoma is a highly aggressive malignancy. Postoperative surveillance after curative-intent surgery remains a matter of debate, without established guidelines for recommended surveillance strategies. This study aims to compare post-recurrence treatment and survival between patients with recurrence detected at scheduled controls versus due to symptoms.
Methods
Retrospective single-center study (2009–2023). All patients were part of a surveillance program, including computed tomography (CT) at 6, 12, 18, 24, and 36 months after surgery. Survival and treatment after recurrence were compared between patients with recurrence detected at scheduled follow-up and those detected between controls due to symptoms.
Results
In total 142 patients were included in the surveillance program. Patient characteristics, including tumor characteristics and neoadjuvant and adjuvant treatment, were similar in both groups. Recurrence detected by scheduled CT was associated with a greater likelihood of receiving post-recurrence treatment (84% versus 68%, P = 0.020). Median overall survival after recurrence for patients detected through scheduled radiological examination was 15 months compared to 9 months for patients detected between controls due to symptoms (15 (7–28) versus 9 (3–17), P = 0.027). For recurrence-free survival, no difference was recorded (15 (12–24) versus 16 months (10–26), P = 0.495).
Discussion
Patients with recurrence detected by scheduled follow-up CT were more likely to receive treatment for recurrence and also had significantly longer overall survival after recurrence compared to patients with recurrence detected due to symptoms.