Abstract and Introduction
Background and Objective: Patients with pancreatic cancer frequently develop postoperative disease recurrence, even after surgical resection with curative intent. Because of the heterogeneity of this patient population, phase III trials have never been conducted to establish a standard therapy for patients with post-surgical recurrence, and no uniform consensus based on high-level evidence exists as to which intervention might be the most appropriate. The aim of this review is to introduce globally popular treatment strategies for pancreatic cancer patients with postoperative recurrences.
Methods: This is a narrative review, summarising the contemporary evidence and emerging studies with treatment for postoperative recurrence of pancreatic cancer.
Key and Content and Findings: For patients with local recurrence alone, various therapeutic strategies have been attempted, including repeat surgical resection, chemoradiotherapy, and chemotherapy alone. Several studies have examined the outcomes of these therapies, but most are retrospective analyses of a small number of patients and statistically too underpowered to allow any solid recommendations to be made. Therefore, with the exception that there appears to be a potential benefit of repeat resection for isolated recurrences in the pancreatic remnant in a selected subgroup of patients, the patient outcomes remain dismal. In regard to the management of patients with distant recurrences, postoperative distant recurrences are generally not considered as being distinct from primary metastatic disease, and most patients with distant recurrence(s) with/without local tumor recurrence receive systemic chemotherapy as the standard therapy for metastatic disease; some studies have demonstrated a trend toward better survival outcomes in patients with a history of surgical resection than in those without a history of surgical resection.
Conclusions: Although no uniform consensus based on high-level evidence exists, systemic chemotherapy has been used as the main treatment option, and some regimens have been demonstrated to offer a survival benefit. There is an urgent need for prospective trials to establish the most appropriate treatment strategies for this patients' population.
Pancreatic cancer remains one of the most challenging malignancies to treat. Of all the modalities available for the treatment of pancreatic cancer, only resection offers an opportunity for cure. However, even among patients with resectable disease, the long-term outcomes remain unsatisfactory, with 5-year survival rates remaining a dismal 10–40%, because most patients develop recurrence even after resection with curative intent.[1–10] It is speculated that the major reasons for these poor outcomes are the presence of occult systemic tumor spread (which are responsible for distant metastasis) even at the time of diagnosis, and the microscopic persistence of malignant cells around the resection area (which are responsible for local recurrence) after a macroscopically curative tumor resection.
This review focuses on the management of local and distant recurrences developing after surgical resection in patients with pancreatic cancer. No phase III trials have ever been conducted in this patient population, and literature on this topic remains limited. While it has therefore been difficult to establish standard management strategies for this category of patients, globally popular treatment strategies for pancreatic cancer patients with postoperative recurrences and future perspectives in this field are introduced in this article. I present the following article in accordance with the Narrative Review reporting checklist (available at https://cco.amegroups.com/article/view/10.21037/cco-21-87/rc).
Chin Clin Oncol. 2022;11(3):19 © 2022 AME Publishing Company