Skip to main content

Advertisement

SpringerLink
Log in

Completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas: report of six cases and a review of the literature

  • ORIGINAL ARTICLE
  • Published:
Langenbeck's Archives of Surgery Aims and scope Submit manuscript

Abstract

Purpose

There are no accepted surgical strategies for the treatment of pancreatic cancer recurrence in the remnant pancreas after initial resection. We retrospectively analyzed our experiences with patients undergoing completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas.

Methods

Six patients with recurrent pancreatic cancer in the remnant pancreas underwent completion pancreatectomy between March 2005 and December 2012. Operative, postoperative, and pathological data and long-term outcomes for these six patients were analyzed retrospectively.

Results

There was no operative morbidity or mortality associated with completion pancreatectomy. The median survival times were 49.0 and 27.5 months after initial resection and second pancreatectomy, respectively. However, all six patients died during follow-up. Five patients had recurrent pancreatic cancer at the time of death. One patient had no recurrence but had poor blood sugar control and eventually died after repeated bouts of cholangitis.

Conclusions

Completion pancreatectomy is a safe and effective option in select patients with local pancreatic cancer recurrence in the remnant pancreas after initial pancreatectomy. It is essential to select patients who have a good performance status and can tolerate major surgery and the resultant apancreatic state.

This is a preview of subscription content, log in via an institution to check access.

Access this article

Log in via an institution

Price excludes VAT (USA)
Tax calculation will be finalised during checkout.

Instant access to the full article PDF.

Institutional subscriptions

Similar content being viewed by others

References

  1. Neoptolemos JP, Stocken DD, Friess H, Bassi C, Dunn JA, Hickey H, Beger H, Fernandez-Cruz L, Dervenis C, Lacaine F, Falconi M, Pederzoli P, Pap A, Spooner D, Kerr DJ, Büchler MW, European Study Group for Pancreatic C (2004) A randomized trial of chemoradiotherapy and chemotherapy after resection of pancreatic cancer. N Engl J Med 350:1200–1210

    Article  CAS  PubMed  Google Scholar 

  2. Winter JM, Cameron JL, Campbell KA, Arnold MA, Chang DC, Coleman J, Hodgin MB, Sauter PK, Hruban RH, Riall TS, Schulick RD, Choti MA, Lillemoe KD, Yeo CJ (2006) 1423 pancreaticoduodenectomies for pancreatic cancer: a single-institution experience. J Gastrointest Surg 10:1199–1210

    Article  PubMed  Google Scholar 

  3. Oettle H, Post S, Neuhaus P, Gellert K, Langrehr J, Ridwelski K, Schramm H, Fahlke J, Zuelke C, Burkart C, Gutberlet K, Kettner E, Schmalenberg H, Weigang-Koehler K, Bechstein WO, Niedergethmann M, Schmidt-Wolf I, Roll L, Doerken B, Riess H (2007) Adjuvant chemotherapy with gemcitabine vs observation in patients undergoing curative-intent resection of pancreatic cancer: a randomized controlled trial. JAMA 297:267–277

    Article  CAS  PubMed  Google Scholar 

  4. Ueno H, Kosuge T, Matsuyama Y, Yamamoto J, Nakao A, Egawa S, Doi R, Monden M, Hatori T, Tanaka M, Shimada M, Kanemitsu K (2009) A randomised phase III trial comparing gemcitabine with surgery-only in patients with resected pancreatic cancer: Japanese Study Group of Adjuvant Therapy for Pancreatic Cancer. Br J Cancer 101:908–915

    Article  PubMed Central  CAS  PubMed  Google Scholar 

  5. Katz MH, Wang H, Fleming JB, Sun CC, Hwang RF, Wolff RA, Varadhachary G, Abbruzzese JL, Crane CH, Krishnan S, Vauthey JN, Abdalla EK, Lee JE, Pisters PW, Evans DB (2009) Long-term survival after multidisciplinary management of resected pancreatic adenocarcinoma. Ann Surg Oncol 16:836–847

    Article  PubMed Central  PubMed  Google Scholar 

  6. Sperti C, Pasquali C, Piccoli A, Pedrazzoli S (1997) Recurrence after resection for ductal adenocarcinoma of the pancreas. World J Surg 21:195–200

    Article  CAS  PubMed  Google Scholar 

  7. Smeenk HG, van Eijck CH, Hop WC, Erdmann J, Tran KC, Debois M, van Cutsem E, van Dekken H, Klinkenbijl JH, Jeekel J (2007) Long-term survival and metastatic pattern of pancreatic and periampullary cancer after adjuvant chemoradiation or observation: long-term results of EORTC trial 40891. Ann Surg 246:734–740

    Article  PubMed  Google Scholar 

  8. Mayo SC, Gilson MM, Herman JM, Cameron JL, Nathan H, Edil BH, Choti MA, Schulick RD, Wolfgang CL, Pawlik TM (2012) Management of patients with pancreatic adenocarcinoma: national trends in patient selection, operative management, and use of adjuvant therapy. J Am Coll Surg 214:33–45

    Article  PubMed Central  PubMed  Google Scholar 

  9. Kleeff J, Reiser C, Hinz U, Bachmann J, Debus J, Jaeger D, Friess H, Büchler MW (2007) Surgery for recurrent pancreatic ductal adenocarcinoma. Ann Surg 245:566–572

    Article  PubMed Central  PubMed  Google Scholar 

  10. Miura F, Takada T, Amano H, Yoshida M, Isaka T, Toyota N, Wada K, Takagi K, Kato K (2007) Repeated pancreatectomy after pancreatoduodenectomy. J Gastrointest Surg 11:179–186

    Article  PubMed  Google Scholar 

  11. Müller MW, Friess H, Kleeff J, Dahmen R, Wagner M, Hinz U, Breisch-Girbig D, Ceyhan GO, Büchler MW (2007) Is there still a role for total pancreatectomy? Ann Surg 246:966–974, discussion 974–975

    Article  PubMed  Google Scholar 

  12. Koizumi M, Sata N, Kasahara N, Morishima K, Sasanuma H, Sakuma Y, Shimizu A, Hyodo M, Yasuda Y (2010) Remnant pancreatectomy for recurrent or metachronous pancreatic carcinoma detected by FDG-PET: two case reports. JOP 11:36–40

    PubMed  Google Scholar 

  13. Crippa S, Tamburrino D, Partelli S, Salvia R, Germenia S, Bassi C, Pederzoli P, Falconi M (2011) Total pancreatectomy: indications, different timing, and perioperative and long-term outcomes. Surgery 149:79–86

    Article  PubMed  Google Scholar 

  14. Lavu H, Nowcid LJ, Klinge MJ, Mahendraraj K, Grenda DR, Sauter PK, Rosato EL, Kennedy EP, Yeo CJ (2011) Reoperative completion pancreatectomy for suspected malignant disease of the pancreas. J Surg Res 170:89–95

    Article  PubMed  Google Scholar 

  15. Thomas RM, Truty MJ, Nogueras-Gonzalez GM, Fleming JB, Vauthey JN, Pisters PW, Lee JE, Rice DC, Hofstetter WL, Wolff RA, Varadhachary GR, Wang H, Katz MH (2012) Selective reoperation for locally recurrent or metastatic pancreatic ductal adenocarcinoma following primary pancreatic resection. J Gastrointest Surg 16:1696–1704

    Article  PubMed  Google Scholar 

  16. Strobel O, Hartwig W, Hackert T, Hinz U, Berens V, Grenacher L, Bergmann F, Debus J, Jäger D, Büchler M, Werner J (2013) Re-resection for isolated local recurrence of pancreatic cancer is feasible, safe, and associated with encouraging survival. Ann Surg Oncol 20:964–972

    Article  PubMed  Google Scholar 

  17. Miyazaki M, Yoshitomi H, Shimizu H, Ohtsuka M, Yoshidome H, Furukawa K, Takayasiki T, Kuboki S, Okamura D, Suzuki D, Nakajima M (2014) Repeat pancreatectomy for pancreatic ductal cancer recurrence in the remnant pancreas after initial pancreatectomy: is it worthwhile? Surgery 155:58–66

    Article  PubMed  Google Scholar 

  18. Sobin LH, Gospodarowicz MK, Wittekind C (2009) TNM classification of malignant tumours, 7th edn. Wiley-Blackwell, New York

    Google Scholar 

  19. Bosman FT, Carneiro F, Hruban RH, Theise ND (2010) WHO classification of tumours of the digestive system, 4th edn. IARC, Lyon

    Google Scholar 

  20. Diabetes Control and Complications Trial Research Group (1993) The effect of intensive treatment of diabetes on the development and progression of long-term complications in insulin-dependent diabetes mellitus. N Engl J Med 329:977–986

    Article  Google Scholar 

  21. Wilkowski R, Thoma M, Bruns C, Duhmke E, Heinemann V (2006) Combined chemoradiotherapy for isolated local recurrence after primary resection of pancreatic cancer. JOP 7:34–40

    PubMed  Google Scholar 

  22. Habermehl D, Brecht IC, Bergmann F, Welzel T, Rieken S, Werner J, Schirmacher P, Büchler MW, Debus J, Combs SE (2013) Chemoradiation in patients with isolated recurrent pancreatic cancer—therapeutical efficacy and probability of re-resection. Radiat Oncol 8:27

    Article  PubMed Central  PubMed  Google Scholar 

  23. Nakamura A, Itasaka S, Takaori K, Kawaguchi Y, Shibuya K, Yoshimura M, Matsuo Y, Mizowaki T, Uemoto S, Hiraoka M (2014) Radiotherapy for patients with isolated local recurrence of primary resected pancreatic cancer. Prolonged disease-free interval associated with favorable prognosis. Strahlenther Onkol 190:485–490

    Article  PubMed  Google Scholar 

  24. Uesaka K, Fukutomi A, Boku N, Kanemoto H, Konishi M, Matsumoto I, Kaneoka Y, Shimizu Y, Nakamori S, Sakamoto H, Morinaga S, Kainuma O, Imai K, Sata N, Hishinuma S, Nakamura T, Kanai M, Hirano S, Yoshikawa Y, Ohashi Y (2013) Randomized phase III trial of adjuvant chemotherapy with gemcitabine versus S-1 for patients with resected pancreatic cancer (JASPAC-01 study). J Clin Oncol 31 (Suppl 34; abstract 145)

  25. Okabayashi T, Shima Y, Iwata J, Morita S, Sumiyoshi T, Kozuki A, Tokumaru T, Iiyama T, Kosaki T, Kobayashi M, Hanazaki K (2014) S-1 vs. gemcitabine as an adjuvant therapy after surgical resection for ductal adenocarcinoma of the pancreas. World J Surg 38:2986–2993

    Article  PubMed  Google Scholar 

Download references

Author information

Authors and Affiliations

  1. Department of Gastroenterological Surgery, Kochi Health Sciences Center, 2125-1 Ike, Kochi, 781-8555, Japan

    Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Tatsuaki Sumiyoshi, Teppei Tokumaru, Yuichi Saisaka & Keiichi Date

  2. Department of Diagnostic Pathology, Kochi Health Sciences Center, Kochi, Japan

    Jun Iwata

Authors
  1. Yasuo Shima
    View author publications

    You can also search for this author in PubMed Google Scholar

  2. Takehiro Okabayashi
    View author publications

    You can also search for this author in PubMed Google Scholar

  3. Akihito Kozuki
    View author publications

    You can also search for this author in PubMed Google Scholar

  4. Tatsuaki Sumiyoshi
    View author publications

    You can also search for this author in PubMed Google Scholar

  5. Teppei Tokumaru
    View author publications

    You can also search for this author in PubMed Google Scholar

  6. Yuichi Saisaka
    View author publications

    You can also search for this author in PubMed Google Scholar

  7. Keiichi Date
    View author publications

    You can also search for this author in PubMed Google Scholar

  8. Jun Iwata
    View author publications

    You can also search for this author in PubMed Google Scholar

Corresponding author

Correspondence to Yasuo Shima.

Ethics declarations

Authors’ contributions

Study conception and design: Yasuo Shima.

Acquisition of data: Yasuo Shima, Takehiro Okabayashi, Akihito Kozuki, Tatsuaki Sumiyoshi, Teppei Tokumaru, Yuichi Saisaka, Keiichi Date, and Jun Iwata.

Analysis and interpretation of data: Yasuo Shima.

Drafting of manuscript: Yasuo Shima.

Critical revision of manuscript: Yasuo Shima and Takehiro Okabayashi.

Funding

This study was funded by Kochi Organization for Medical Reformation and Renewal Grants.

Conflicts of interest

The authors declare that they have no conflicts of interest.

Ethical approval

For this type of study, formal consent is not required.

Rights and permissions

Reprints and permissions

About this article

Check for updates. Verify currency and authenticity via CrossMark

Cite this article

Shima, Y., Okabayashi, T., Kozuki, A. et al. Completion pancreatectomy for recurrent pancreatic cancer in the remnant pancreas: report of six cases and a review of the literature. Langenbecks Arch Surg 400, 973–978 (2015). https://doi.org/10.1007/s00423-015-1355-2

Download citation

  • Received:

  • Accepted:

  • Published:

  • Issue Date:

  • DOI: https://doi.org/10.1007/s00423-015-1355-2

Keywords

Search

Navigation