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Pancreatic cancer arising from the remnant pancreas after pancreatectomy: a multicenter retrospective study by the Kyushu Study Group of Clinical Cancer

  • Daisuke Hashimoto
  • Kota Arima
  • Shigeki Nakagawa
  • Yuji Negoro
  • Toshihiko Hirata
  • Masahiko Hirota
  • Masafumi Inomata
  • Kengo Fukuzawa
  • Takefumi Ohga
  • Hiroshi Saeki
  • Eiji Oki
  • Yo-ichi Yamashita
  • Akira Chikamoto
  • Hideo Baba
  • Yoshihiko Maehara
Original Article—Liver, Pancreas, and Biliary Tract
  • 62 Downloads

Abstract

Background

After initial pancreatic resection, local recurrence of pancreatic cancer (PC) or new primary PC can develop in the remnant. There are limited data available regarding this so-called remnant PC. The aim of this retrospective study was to clarify the clinical features and establish a treatment strategy for remnant PC.

Methods

A multicenter retrospective study with the Kyushu Study Group of Clinical Cancer was carried out. Clinical data from 50 patients who developed remnant PC were analyzed. RAS mutation analysis of the initial tumor and of remnant PC was performed in 17 cases.

Results

The initial pancreatic resections were performed for 37 invasive ductal carcinomas, and for 13 other tumors. Thirty-seven patients underwent a second pancreatectomy for remnant PC (resected group), while thirteen patients were not operated (unresected group). The median overall survival times were 42.2 months in the resected group and 12.3 months in the unresected group (HR 0.374; 95% CI 0.17–0.83). In RAS mutation analysis, 14 cases had at least 1 missense variant of KRAS, HRAS, or NRAS in the initial pancreatic tumor and/or remnant PC. The same missense variants between the initial tumor and remnant PC were discovered only in KRAS of one patient, and in HRAS of one patient. No case had completely consistent missense variants between the initial tumor and remnant PC.

Conclusions

This study found that repeated pancreatectomy for remnant PC can prolong patient survival, and RAS mutation analysis indicated that many remnant PCs are developed from metachronous multifocal origins.

Keywords

Pancreatic cancer RAS Local recurrence Operation Complication 

Notes

Acknowledgements

The authors thank the following institutions and investigators who participated in this study: Miyake K (Kumamoto University), Yonemura A (Kumamoto University), Yoshida M (Kumamoto University), Utsunomiya T (Oita Prefectural Hospital), Eguchi S (Nagasaki University Hospital), Kawanaka H (Beppu Medical Center), Kusumoto T (Kyusyu Medical Cnter), Okumura H (Kagoshima Koseiren Hospital). We also thank Sakamoto S and the staff at the Clinical Research Support Center Kyushu (CReS Kyushu) for their excellent data collection, management, and secretarial assistance. This work was supported by CReS Kyushu with no funding. We thank Maki S for grammatical editing of a draft of this manuscript.

Funding

No financial support or funding was received for this study.

Compliance with ethical standards

Conflict to interest

Hashimoto D and all co-authors have no conflict to interest.

Supplementary material

535_2018_1535_MOESM1_ESM.docx (17 kb)
Supplementary material 1 (DOCX 16 kb)
535_2018_1535_MOESM2_ESM.docx (48 kb)
Supplementary material 2 (DOCX 48 kb)

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Copyright information

© Japanese Society of Gastroenterology 2018

Authors and Affiliations

  • Daisuke Hashimoto
    • 1
    • 2
  • Kota Arima
    • 1
  • Shigeki Nakagawa
    • 1
  • Yuji Negoro
    • 3
  • Toshihiko Hirata
    • 4
  • Masahiko Hirota
    • 5
  • Masafumi Inomata
    • 6
  • Kengo Fukuzawa
    • 7
  • Takefumi Ohga
    • 8
  • Hiroshi Saeki
    • 9
  • Eiji Oki
    • 9
  • Yo-ichi Yamashita
    • 1
  • Akira Chikamoto
    • 1
  • Hideo Baba
    • 1
  • Yoshihiko Maehara
    • 9
  1. 1.Department of Gastroenterological SurgeryKumamoto University Graduate School of Medical SciencesKumamotoJapan
  2. 2.Department of Gastroenterological SurgeryOmuta Tenryo HospitalOmutaJapan
  3. 3.Department of GastroenterologyKochi Health Sciences CenterKochiJapan
  4. 4.Department of SurgeryJapanese Red Cross Kumamoto HospitalKumamotoJapan
  5. 5.Department of SurgeryKumamoto Regional Medical CenterKumamotoJapan
  6. 6.Department of Gastroenterological and Pediatric SurgeryOita University, Faculty of MedicineOitaJapan
  7. 7.Department of SurgeryOita Red Cross HospitalOitaJapan
  8. 8.Department of SurgeryFukuoka Higashi Medical CenterKogaJapan
  9. 9.Department of Surgery and ScienceKyushu University Graduate School of Medical SciencesFukuokaJapan

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