Recurrence patterns of pancreatic cancer after pancreatoduodenectomy: systematic review and a single-centre retrospective study

Marit Kalisvaart, Damian Broadhurst, Francesca Marcon, Rupaly Pande, Andrea Schlegel, Robert Sutcliffe, Ravi Marudanayagam, Darius Mirza, Nikolaos Chatzizacharias, Manuel Abradelo, Paolo Muiesan, John Isaac, Yuk T. Ma, Christopher Mcconville, Keith Roberts

Research output: Contribution to journalArticlepeer-review

6 Citations (Scopus)


Background: Positive margins in pancreatoduodenectomy (PD) for pancreatic cancer, specifically the superior mesenteric artery (SMA) margin, are associated with worse outcomes. Local therapies targeting these margins could impact on recurrence. This study analysed recurrence-patterns to identify whether strategies to control local disease could have a meaningful impact.

Methods: (I) Systematic review to define recurrence patterns and resection margin status. (II) Additional retrospective study of PD performed at our centre.

Results: In the systematic review, 23/617 evaluated studies were included (n = 3815). Local recurrence was observed in 7–69%. SMA margin (6 studies) was positive in 15–35%. In the retrospective study (n = 204), local recurrence was more frequently observed with a positive SMA margin (66 vs.45%; p = 0.005). Furthermore, in a multivariate cox-proportional hazard model, only a positive SMA margin was associated with disease recurrence (HR 1.615; 95%CI 1.127–2.315; p = 0.009). Interestingly, median overall survival was 20 months and similar for patients who developed local only, metastases only or simultaneous recurrence (p = 0.124).

Conclusion: Local recurrence of pancreatic cancer is common and associated with similar mortality rates as those who present with simultaneous or metastatic recurrence. Involvement of the SMA margin is an independent predictor for disease progression and should be the target of future adjuvant local therapies.

Original languageEnglish
Pages (from-to)1240-1249
JournalHPB : the official journal of the International Hepato Pancreato Biliary Association
Issue number9
Publication statusPublished - 8 Feb 2020

ASJC Scopus subject areas

  • Hepatology
  • Gastroenterology


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